HomeMy WebLinkAbout2023 Sign Off Transmittal - Deck replacement o� qk TOWN OF YARMOUTH
4i4A4 c HEALTH DEPARTMENT
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PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: j I - 3 3 Cav,ve M A& �A 4 t7U 41i
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Pr posed Improvement: q e r C e 1'h z C•�- t fi °e L K �ti e k) RA,� e t /Y e� 50,44,be;
iNe JAM e LA)! 3 j ACNed IA- -1.o �h Kvc,S e tail /fit Pol715 r05-E- ee�► // 5e
d�56.tiok,bes AM e cent 11 H've NAty 5 Whea ,veer( .
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Applicant: 1 O N U nJ e,S Tel. No.: ,r j 0 W- 360 O'6 F
Address: c[.. 5 )-o/u I C \ I FF t`i 0 ( eiv-tegvi l I e, Date Filed:
**If you would like e-mail notification of sign off,please provide e-mail address: 1 j I O g i S it'L'N e 5 yi ci iM, r C- (O.'V)
Owner Name: / A f [0 /(/I)iv e C
Owner Address: 02 -/-o,ti C iirF AeO (a 1/ Owner Tel. No.: 50 - D6,8
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: S - �3
PLEASE NOTE
COMMENTS/CONDITIONS:
� � 30'�" ; -4- G 9,��'�� `ram
3.346' — L'/ orr , j, 11'
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MAP NO: o17 -
LOT NO. : / l ADDRESS : 3! S 3 3 Cann "—rc
OWNERS NAME : 1Vei ctar S, )tci
SEWAGE PERMIT NO. : -- NEW: '— REPAIR
DATE LAM: DATE INSTALLED :
INSTALLERS NAME : / g ci,c,,,`
INSTALLATION OF: is-G 1`S 3,'7v-crs CcA2V,
WATER TABLE : FINAL INSPECTION BY:
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