HomeMy WebLinkAbouthealth sign off 222023 �,t-_Y4 TOWN OF YARMOUTH
.e HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: 7,1) 0 L0 Jv't14 1 SO ,$V,Maiikt
Proposed Improvement: as, / t .l il• W e 1(.{��# I$S L•1 t tj( 1{0 /CIA a ( -� 1,►dL
-6106v 16 le 0U4 i(t
Applicant: 1j . I S Ul1y SIt1 u Tel. No.: 5N 31(4 ' 'k(
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Address: 2.I?j o I a N c ifl cif &-'ftt O(yY%NA Date Filed:
*s/fyou would like e-mail notification of si n off please provide e-mail address: es 3itiAct0(jVede G� d .Ldfin
Owner Name: 'D �, S vA �V (l�1 `
Owner Address: 2 le (jd ,,,at. S+ Owner Tel. No.:M "3CL1_1 V-tt
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;
- -u -- (2.) Floor plan labeling ALL rooms within building
Q23 (all existing and proposed) -
AN 2 Note: Floor plans not required for decks,sheds, windows, roofing;
HEALTH DEPT, (3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: te - DATE: -a
Y
COMMENTS/CON ITIO
PLEASE NOTE
NS: