HomeMy WebLinkAbout2023 Sign off Transmittal - Inground Pool 0-1/4Y4 TOWN OF YARMOUTH
4 HEALTH DEPARTMENT
'' `` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:Building Site Location: 31 0/;5cor Al✓e, csr>111 ,O1 c j0 It , /74
Proposed Improvement: ,, ,VI 9 YO US V►h y/ P00/ 05VIc i f1
Applicant: C./ecvy wq kir (U 515 Ph Too Is self v►ces Tel. No.: 5CP 2�/- 0 0,?,
Address: 4/ .5/SSo I �A°, I/a 1 W i c / 1 1 02‘�( Date Filed: 4 /2 0%
**Ifyou would like e-mail notification of sign off,please provide e-mail address: ltpe1)6) 64641e VXt5Oy))//y 'a hd56 (n
veYOwner Name: 63 1( 0 ' av CoI Owner Address: 31 3ll5c- Ave, ScU ll+ Kr vho u-1 ittA Owner Tel. No.:3-0? 366 /572
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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.
RECEIVED Please submit three (3) copies of plans, to include:
(1.) Site Plan showing existing buildings, water line location,
APR 1 2023 and septic system location;
HEALTH DEFT (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: Q,Y•-� ��c.,�t __. DATE: S -,1 3 • 3
PLEASE NOTE
COMMENTS/CONDITIONS:
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