HomeMy WebLinkAboutHEALTH SIGN OFF r.t,,f..Y44,P TOWN OF YARMOUTH
c HEALTH DEPARTMENT
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PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
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Building Site Location: q P A.s,u4 cam- C�r,� , ! ,,,„,` 4)�'� - ,/ C 6
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Proposed Improvement: - ..k, ;,,s— auc,A;4, —, %0c)a1/4. GC;4(t..t_ / 4.,'� ('� /`-
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Applicant: .k.Pt�l� ���, .� -
Tel. No.: '-pia 32- y7,57
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Address: 4 el'c �,Wr( L (L -`e--- Cis L`-6' YCl('Nwc.s.kt FirL Date Filed: 7 / c� Q'h.Z.-
"If you would like e-mail notification of sign off please provide e-mail address: )..e0(1/4)40 ,�A 7-e (l-e , c-Lr--►
Owner Name: 1-,-e vN--- A)C. , 0/v.k—'-�
Owner Address: /Oti c e-VI T" (v(--e.-. C r c`-t- Owner Tel. No.: - 3 7- ()i7S�i
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,
IReEpp and septic system location;
(2.) Floor plan labeling ALL rooms within building
JUL 2 6 2027 (all existing and proposed) —
HEALTH DEPT. 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: DATE:
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P EASE NOTE
COMMENTS/CONDITIONS:
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