HomeMy WebLinkAbout2022 Sign off Transmittal - Replace existing Deck .6t_.Y k44 TOWN OF YARMOUTH
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HEALTH DEPARTMENT
�• PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant: RECEIVED
Building Site Location: / 4:07_7211,,/ 1,l iciax54Al
Proposed Improvement: *p 9 , J c,K HEALTH DEPT.
Applicant: x7D SJN Tel. No.:,s _39y_347c
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Address: / r)A7777,./A1 /V/e, dn/ r Date Filed: /6r_ 7_,?7,7,z,
**/fyou would like e-mail notification of sign off please provide e-mail address:
Owner Nam : /c/4427.2) 4 Vie_ezp, Sz i{/�4Jtl
Owner Address: / KPz yA/ / c A J ' ) Owner Tel. No.: ,5-4,57 39J 3✓-z,5—
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: 0-\_____
DATE: /O/l1) 2'Z
PLEASE NOTE
COMMENTS/CONDITIONS:
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