HomeMy WebLinkAbout2022 Sign off Transmittal - Fix existing walkway TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant. ,,
Building Site Location: '// /9&//t/7 27c12A} � , A/Ve,
Proposed Improvement: ADD/Ale) yXb /?r k/2,f/Gjel L .Sv`',/2
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Applicant: l h//181 A �/4/ 4 Tel. No.:,s4g:3 W"3O8U
Address: A(= L�U/244 h S �A/�� Date Filed: S/-2,2
"If you would like e-mail notification of sign off, please provide e-mail address:
Owner Name: 71/iL14 Sm l f A
Owner Address: '/l /2',Q7 6/2,rq/? S Xi/Ale Owner Tel. No.:$2-`,3c'8-3, 0
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;
X 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: DATE: 7 - acI-
LEASE NOTE
COMMENTS/CONDITIONS: RECEIVED
HEALTH fFPT
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