HomeMy WebLinkAboutHealth sign off ° ' TOWN OF YARMOUTH
y HEALTH DEPARTMENT
` `' "` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
, To be completed by Applicant:
Building Site Location: 9 Ca I I-- 1.--4\ 1 V V , 0:Ifv\sw)-6-. Y1 °
Proposed Improvement: jb K l 2Ivc), S e
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Applicant: C) 0'e- i \ e- qvv, ; 1.
� Tel. No.: 6 1 7 g Q 3 29/.
Address: C (,ZA.e l_rk V"\1 Q r- oN, Date Filed:
**If you would like e-mail notification of sign off,please provide e-mail address:
Owner Name: -0 '... Ke ce
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Owner Address: t C 41-t; wner Tel. No.: G'17 0 p
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• 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:
RECEIVED (1.) Site Plan showing existing buildings,water line location,
and septic system location;
(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.
•
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COMMENTS/COND IONS: PLEASE NOTE
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