HomeMy WebLinkAboutUntitled r°t.Y ,> TOWN OF YARMOUTH
HEALTH DEPARTMENT
'�•` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: )04 of ft 3r-iv-e
Proposed Improvement: jl✓a/i/za - )Q/ :'�l} E 'fy-,/c7
Applicant: h'/< / / _ii/ �._ Tel. No.: G'�'" 3 5- S/>�
Address: ,S(2 j 44, .SI DT- Date Filed: A7- -
**/fyou would like e-mail notification of sign off, please provide e-mail address:
Owner Name: fijix,
Owner Address: S Owner Tel. No.: )74.e
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
Please submit three (3) copies of plans, to include:
(1.) Site Plan showing existing buildings, water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
Note: Floor plans not required for decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: t Jt'L DATE: 2_ 1-'° ) 2 4'Zv
PLEASE NOTE
COMMENTS/CONDITIONS:
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