HomeMy WebLinkAbout2022 Sign off Transmittal - New Deck/Roofing •
'%it TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant. /
Building Site Location: a f1?' �`'"� �J� / .1/l� ��'7 , 0 2 3
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Proposed Improvement: `t-It ort.' r
Applicant: (A115 / ,2 Y ref k/ Tel. No.: 1/43-2 Co--Fog('
Address: A P.44. � be,,c s 7- )/e2,Ar Date Filed: fi j /).—
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**lfyou would like e-mail notification of sign off please provide e-mail address: F 1 6- 6 Y6 Pra eeom
Owner Name: / kf•-t4e Xp !4/ r ens 6' r
Owner Address: a /4A7 4 vts r ytrA,i4 o.irrtvrnwner Tel. No.: WY-250 a 9s
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: /lNA,/ 2=
PLEASE NOTE
COMMENTS/CONDITIONS:
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