HomeMy WebLinkAbout2023 Sign off Transmittal - Use & Occ Vacasa Inc - Rental/Real Eastate Office i
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° :7 't TOWN OF YARMOUTH
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o( A ,;� HEALTH DEPARTMENT
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PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: _c 6. I. 0 c C ) S3 D S--E
Proposed Improvement: N (/4- Re ( 2.--3. \ e � c
Applicant: ��CQS&. �C--
Tel. No.: 1 1 1-{- 2,2s- 30-/c9
Address: /2 53 1,4-e-- 2 ' S y.t vMa v 11 .Z t;.C ( Date Filed: /2 3/Z
**If you would like a-mail notification of sign off please provide e-mail address: jab. S Chm id-J c -S CA.• C'''?
Owner Name: ''] w vpo r i- I -I-r
Owner Address: 2.0 p main S4 S ,•'(,v 0.1 f t A Owner Tel. No.: 50g- 39e 2.3
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.
REVIEWED BY: /9�_e..,, 4,,,,1 ,e.,t0 DATE: 3l .3723
PLEASE NOTE
COMMENTS/CONDITIONS:
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