HomeMy WebLinkAbout2022 Sign off Transmittal - Dormer 444AcINY4, TOWN OF YARMOUTH
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r HEALTH DEPARTMENT
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'�• ` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant.
Building Site Location: e Pik)Tv IAN DL, E • SWOT I{ ,Nl R OoZ<o�o LI
71)(7`1
Proposed Improvement: Dp'062 r 2.T,all MCA. Si 66 fr'Cµ/400m
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Applicant: U6 (/1,SNO() CRfew,2.f (t\JCi Tel. No.: 5OR 360 )55(
Address: i s egveocesr ,ieir e.,`Nl$ O0646( Date Filed: /0/04 22
**lfyou would like e-mail notification of sign off, please provide e-mail address: 1/8.C,uSfoMGA.{isNTeya 6r L •CoM
Owner Name: v6 COMM C PAN irz/ l6)c/
Owner Address: I t'1ivaJLeS( 02, rritz<rthltc ,m h c4 4 Owner Tel. No.: Cog 369 a-c7
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:
RECEIVED (1.) Site Plan showing existing buildings, water line location,
and septic system location;
)02.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
HEALTH DEPT. Note: Floor plans not required for decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
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REVIEWED BY: DATE:
LEASE NOTE
COMMENTS/CONDITIONS: ;� I �U� S
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