HomeMy WebLinkAbout2022 Sign Off Transmittal - Remodeling Front & Back Porches TOWN OF YARMOUTH
S HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:Building Site Location: °�3 S.Z' I l( 1RIX QJ S. [�7t v(mEt2,//rif /"/t/
A 02669
Proposed Improvement: Re,.yyt$ QI/!V Fp.enIj- Po Acif Aid /getek fa,Qic�f-(
Applicant: pt vi l r j 1-,i i PPV Tel. No.: S0 342 • �( �
Address: tea $ q t (( Pccit, U S, Ya: ,vtau -let Date Filed: 402/202'Z
"If you would like e-mail notification of sign off please provide e-mail address:
Owner Name: 0;41 i -f Q•j(1 Fir)/pPcx-V
Owner Address: 3 ; I I )3 R@ s:V.IR S, 7C 1. 4 (&l 7j? Owner Tel. No.: cOg• 332 -G(oA_
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,
RECEIVED and septic system location;
NOV 0 2 2022 (2.) 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.
•
REVIEWED BY: DATE: ll/43\1(2N
PLEASE NOTE
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