HomeMy WebLinkAbout2022 Sign off Transmittal - Kitchen addition, deck removal, patio added r.,,�:Yk�, TOWN OF YARMOUTH
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HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant.
Building Site Location: 6.57 7 lJ t BOlE S+. S • tya 1 O 1 1 ) )19 C'-
Proposed Improve ent: t Piitnr^ i"eI7I7I ri 746 —�
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Applicant: A C�,cQt - ,�yt..� Tel. No.:,�o -
Address: P Do f e, G O l 2Date Filed: 1)/l5/20,
**If you would like e-mail notification of sign off, please provide e-mail address: a %C e. $/I A. t S*'PYl 1 e fl*tj
Owner Name: 'eJ&ot d. LS/i .Tr
D -3c � - ` 5-
, h own rT
Owner Address: � V O/64A I'l InOGt Owner Tel. No.: 5
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:
d (1.) Site Plan showing existing buildings, water line location,
and septic system location;
NOV 15 2022 (2.) Floor plan labeling ALL rooms within building
_ (all existing and proposed) —
HEAL. . - Note: Floor plans not required for decks, sheds, windows, roofing;
f g;
(3.) If necessary, Title 5 application signed by licensed installer
'th fee.
REVIEWED BY: DATE: l/ — —
PLEASE NOTE
COMMENTS/CONDITIONS:
14-0L/Se i �GI lie / Be ��G r