HomeMy WebLinkAboutHEALTH SIGN OFF ���.Y'►k TOWN OF YARMOUTH
HEALTH DEPARTMENT
•
'' (``• PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location:
Proposed Improvement:
Applicant: �: , (vc� y ''T-QUC---t—/ Qom' Tel. No.: 4- 63%,z!
Address: z�6) (,,A) N 4ceiirvtJ h 4_. Date Filed:
**lfyou would like e-mail notification of sign off,please provide e-mail address: r,I /1_11 ,
t Owner Name: `c C"' i v �-6_2
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Owner Address: - ! '7 ( a P oolz t-►IQL. 7` Owner Tel. No.: G/%-3 y7-• C3sq
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: DATE: J �
PLEASE NOTE
COMMENTS/CONDITIONS:
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TOWN OF YARMOUTH
;*1 HEALTH DEPARTMENT
'�• `` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: I�,Jc-.p .
Proposed Improvement: v t D + i f2AZ b‘-1 t'C711-7"1 0 y
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Applicant: eN(2m1 Tel. No.: e 396 3 _.3C�
Address: -2-( S ( -rt 1\L T C-( cue 1)- pcA? Date Filed: ZS-h.
**/fyou would like e-mail notification of sign off please provide e-mail address:
Owner Name: _
Owner Address: i7 Loi,36 FCC) 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:
(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: /7 DATE: 7-`" /PISS NOTE
COMMENTS/CONDITIONS:
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