HomeMy WebLinkAbout2023 Sign off Transmittal - Roof on existing patio 0N--'''+k4, TOWN OF YARMOUTH
;:-74g A r HEALTH DEPARTMENT
'• ,,,-- PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: 35"- u t-6 . 5�) .Gt-N int-le.C3 t\ MA cZbby
Proposed Improvement: c3?E+.. ka fF c,uf,?.. E N5\-\ ?tt' , `t log 3q
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Applicant: We-Li\v-A€ KAN DERtAr-' Tel. No.:lor4. (cF11l • k351
Address: 354 tom.'-As- ?c:Lti `1re_l S•1. -O L) RIc c2Loy Date Filed: \INg\23
**/f you would like e-mail notification of sign off please provide e-mail address: mX\,....a.Q60d\p c�1�t'�lo„\- e.,a,ty\
Owner Name: ► t?%P‘t. Y-- G�Zt�ou
Owner Address: 3�-• -Q.4.-. p'?. \ S•`\P+' e_ 1 Owner Tel. No.:b01. b"1Lt.1054
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 (1.) Site Plan showing existing buildings, water line location,
and septic system location;
JAN 18 2023 (2.) Floor plan labeling ALL rooms within building
HEALTH DEPT. (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: (6)Q
DATE: C l g1)--'
PLEASE NOTE
COMMENTS/CONDITIONS:
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• LOT E1 ,r-
0, 9 21,301.8 ± Sr.
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DeeityO.fS
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.: k99.1 •
EXf q $ R4ou' ••
,r•98.5 •
SOIL
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o SHED 100,0 99.5
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•99.8 99.6 • ,,..
99.8 • . „!
150E GALLON BOX 1
- -SEPTiC TANK 1.
- - it 99.2 /
JAN 1 8 Z Z3
HEAL1"H.DEFT
70.00' ' �"