HomeMy WebLinkAboutBLD-23-002538 health sign of 3LD- z3- 40
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YAK TOWN OF YARMOUTH
HEALTH DEPARTMENT
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'*� ° PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 7 ,Zc �
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Proposed Improvement: kid 'ffeiritS'� ' ' r /. ,4
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Applicant: ii_S :+s* Tel.No.: (07-1753
Address: 20 5u6& Dr Date Filed: / f/i2,91)
"If you would like e-mail notification of sign off please provide e-mail address:j / /Meltkla? & -� ee (e '�
Owner Name: ,4NNci /Te14eA1SIff
Owner Address: 6 V/i'? L/" Owner Tel.No.:
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:
NOV 0 3 2022 (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: / / 3/2-2=
PLEASE NOTE
COMMENTS/CONDITIONS:
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