HomeMy WebLinkAbout2022 Sign off Transmittal - Replace Deck r_,,t Y� c TOWN OF YARMOUTH OCT 0 4 2022
HEALTH DEPARTMENT
o := �' HEALTH DEPT.
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: 9 L'Oltik 'qq A Ve h vq_ -Sai\ or,ot eN
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Proposed Improvement: re C�� d4 L_ c�c� J��—'� c& J i.("' re, ri,00 ei,(
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Applicant: � �� CiF'� �QC i ^) 2 Lf D4j--'(°7(f
Address: J5 � � L U��—� - c�
Y� _�• CJv� m00 Date Filed: l0 :3/0a
**If you would like e-mail notification of sign off please provide e-mail address:
Owner Name:
Owner Address: ` ) � r r� Aue, S, t� Owner Tel. No.:77 9"II.), ii9763
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: DATE: �� 1
PLEASE NOTE
COMMENTS/CONDITIONS: