HomeMy WebLinkAbout2023 Sign off Transmittal OV*Y4A TOWN OF YARMOUTH
v\ HEALTH DEPARTMENT
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==" PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant: `�,'
Building Site Location: ,2 G i? b J4)/Y t� (1b�(??3
Proposed Improvement: CfreA4-10 ;4. t e --1). t rt ..(-, �t✓J ve '
Applicant: �� t j� Tel. No.:
Address: Q'Q 61e0A Ii 5 Pitot4OM Date Filed: 0-343
**If you would like e-mail notification of sign off please provide e-mail address: V //e a456[& /`IeaC,er"7
Owner Name: Z aOk
Owner Address: d r/e I/ cP,� $2'(41IC42t72 Owner Tel. No.: S—OS``t qg—cZV
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;
f
N24? '' (2.) Floor plan labeling ALL rooms within building
Fq 023 (all existing and proposed) —
ly '< n 7. 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: t ,�--5 r - 3
PLEASE NOTE
COMMENTS/CONDITIONS:
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