HomeMy WebLinkAbout2022 Sign off Transmittal - Replace front steps TOWN OF YARMOUTH
Tlo HEALTH DEPARTMENT
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NCO", PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: t/f7gtt-7X 4/4
Proposed Improvement: W / '. ' tic/�+ .,r✓
Applicant: <.J'..5 Tel.No.: 7 'Y82/2,-
Address: 20 8LicktizeolDr Date Filed: I! 1 )L?
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**If you would like e-mail notification of sign off,please provide e-mail address:j �itr C16 Q/ /7etf it`C�f
Owner Name: 4NMt / 1// Vs,fJ
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Owner Address: 6 . J/za Lit Owner Tel. No.:
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:
NOV 0 3 2022 (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: / / 3 .Z2
PLEASE NOTE
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