HomeMy WebLinkAboutBLD-23-003046 health sign off 3ZZ) _23 '3oy,6
o . TOWN OF YARMOUTH
.ii1-tti,cr HEALTH DEPARTMENT
' ., co,- PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: y lc-
S 'J 90 im citkIX )) a.2C1-2 s
Proposed Improvement: ('O y,v-' r l ip A t f C.14` _ - -d'i i- 7 no ar, Ted iL)d.1
k r. *-- 1- 1 A c / -7
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Applicant: J lI'I►� U 'B(AJ-e•,
Tel. No.: g ),- ,5-(,1U- Po (0
Address: 3 YY Ore S I 2U Uri n 1&tJ1- , a Le-- d 2-69 7 Date Filed: 1 \/_a /
**If you would like e-mail notification of sign off please provide e-mail address:
Owner Napie: Alt j 0 , g C i ta--N
Owner Address: .tit'( 6' (- _S o' . Owner Tel. No.: 9? "---b''- 0006,
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.
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REVIEWED BY: 6)-a,__ r.- ...--rl{---
DATE: / 02_
PLEASE NOTE
COMMENTS/CONDITIONS:
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