HomeMy WebLinkAbout2022 Sign off Transmittal - Inground Pool TOWN OF YARMOUTH RECEIVED
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HEALTH DEPARTMENT
OCT 2 4 2022
''�• '� PERMIT APPLICATION SIGN OFF TRANSMITTAL IIE TT
HEN ill DEPT.
To he completed by Applicant:
Y(xf Building Site Location: 5pGruVec moo
Proposed Im - vement: ii'U 1 b Ill c inVii vt Jplaki `1-50
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Applicant: 65 /V C 4 Ai-Ale- Tel. No.: O 3 " is
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Address: 3Po
tActS }Pad 1-KGcti,)' 4 et Filed: Z 2O 22—
**/f you would like e-mail notification of sign offplease provide e-mail address:
Owner Name: Lo `(,u A- t' çL13 (\)
Owner Address: DES' D v rcyrnoal prw4isiyOwner Tel. No.: S'03 —72 Z-/d
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: /9 Y d-+�
PLEASE NOTE
COMMENTS/CONDITIONS: