HomeMy WebLinkAboutUntitled Yak TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: I? ( tot Ln . JyarM rl41v+ ,!/ 0 d6 5/
Proposed Improvement: 'f\ (h i J a O2(MJ i JJ ��c , D co e (e
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Applicant: I SQ_/Y►'' "D (e}. Tel. No.: ,v 5 3i i 9S3
Address: (a1,11-eki Ln f y701M A Date Filed: /o/7�2c2e._
**Ifyou would like e-mail notification of sign off, please provide e-mail address:
Owner Name:N \
Owner Address: \ GranberN taw_ S• prIlitt* Owner Tel. No.: j '3(5"9 I5 3
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,
rj i ro and septic system location;
22 (2.) Floor plan labeling ALL rooms within building
HEALTH DEPT. (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: /C) (t SY )-
PLEASE NOTE
COMMENTS/CONDITIONS:
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