HomeMy WebLinkAbout2023 Sign off Transmittal - Use & Occ. Barnstable Canvas Co. oc'YgR TOWN OF YARMOUTH
o E,;; ' - ,y HEALTH DEPARTMENT
'''• •` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:Building Site Location: 1/ /1/2-,///1 y 7'V 4-- .571-
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Proposed Improvement: u 5e g occ,
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Applicant: .,./€7.. fir-4 l/ y "7✓�/ Tel. No.: SCE 7`i0 "7 28 7
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Address: G 2/P /2 74ri ,S' A Ai yirite,)•?<-- o°z-G 7 3 Date Filed: �/57,23
**If you would like e-mail notification of sign off,please provide e-mail address: AV-4 S4 S/cC an ✓4 s 9de.,boo. Co
Owner Name: /e.(11#-e J `1 v-r y
Owner Address:,91--/ R/Vt t' S11-, 5. y i&.A-- O ZGG&( Owner Tel. No.: 5? ?7'-1 c y7
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:
RECEIVED (1.) Site Plan showing existing buildings, water line location,
and septic system location;
APR rig 2023 (2.) Floor plan labeling ALL rooms within building
(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: G✓•--�oA. DATE:
PLEASE NOTE
COMMENTS/CONDITIONS:
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RECEIVED
APR 03 2023
HEALTH DEPT.