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HomeMy WebLinkAbout2022 Sign off Transmittal - Ingroud Pool of . qR TOWN OF YARMOUTH �� `le'ep. HEALTH DEPT. G HEALTH DEPARTMENT o ,. ,„ )-4 \.4. "y'� r PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: 16- 1,e,n 1-e f b 0 u-& Lc u l e_ , S D IAA-Pk G1'11103 44 Proposed Improvement: Lfl S 0 6t4-fey) oI ('ti 0 R)L)nd 6 bo:in to Q /. Applicant: 3 L-A e n 0 L s Tel.No.: s 8-- 33 4 e- Tr? 7 Address: j 2 1 W k,+-es ,9etz+f/k , S. \-1 G�-{O1 by ' Date Filed: 614.3- X b-a-a v► t /- o & G (o L1 **If you would like e-mail notification of sign off please provide e-mail address: Owner Name: (L,(-6.1 A}- 'l�-`l N A_ k l) N Owner Address: LP I (its i l I i (uvi SbUr7j 0-0 Ci_cl Owner Tel. No.: S lR 0 — "l i ...�-rI 6 Oi(T. 3 h. C.I i ©Le 4 -1 ► ?3 q 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: I 1 73 c/i ..• PLEASE NOTE COMMENTS/CONDITIONS: