HomeMy WebLinkAbout2022 Sign off Transmittal - Replace front porch / deck TOWN OF YARMOUTH
r HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant.
Building Site Location: 90-rr \ SA.ktoK
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Proposed Improvement: ?2- rk q Ge- ;o l- r io a /C!1 e k 1 o \i<
Applicant: e7c)e, -- c\n to Tel. No.: SV is—' 7 7C.,'3SO
Address: `foci �1 fiov1 'e Date Filed:/ -/ �' Z
**/fyou would like e-mail notification of sign off please provide e-mail address:
Owner Name:
Owner Address: 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:
(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: / 0 -
PLEASE NOTE
COMMENTS/CONDITIONS: