HomeMy WebLinkAboutUntitled .0 TOWN OF YARMOUTH
c HEALTH DEPARTMENT
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` G"` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: I U 1'"�` 241 L9- - p
Proposed Improvement: Lh,so /f al 1l ,,a AOC(e_ d, &-L C CC
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Applicant: /V Tel. No.:(ai) �/��/ 4/3
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Address: 2J d_cv /L 4.)ay T et$I/22
JQJ2 N14 6 j Date Filed: 5 I LO-02 3
**Ifyou would like e-mail notification of sign off please provide e-mail address:
Owner Name: De., hti0---S
Owner Address: Z Le l h;`r'R-d ( r7t$ , Owner Tel. No.:`77 ' -45--5/- 57
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;
G u%D\-VC D (2.) Floor plan labeling ALL rooms within building
MAR 1 4 2023 (all existing and proposed)—
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: � C DATE: "r-
PLEASE NOTE
COMMENTS/CONDITIONS:
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