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2023 Sign off Transmittal - Resubmit for expired sign off
F'Yg4 TOWN OF YARMOUTH RECEIVED `f � °` HEALTH DEPARTMENT ' �� MAY 19 2023 � ''•�M```4 PERMIT APPLICATION SIGN OFF TRANSMITTAL SHREALTH DEPT. To be completed by Applicant: Building Site Location: 67 / 72e2, D1 -' t--z/ ` 1 -' /-7,46bu'7j/ Proposed Improvement: S �L eR/(7/ U S L-- 4 �-f 4 C- /it- ift,, 2.--/t- C-�'-?L -Z k-ec Applicant: % 44, &e Z 0(a..r7. Tel. No.: ` t- ' 3S. Address: ,S {--u.C-C= Date Filed: PE, /d ? S **If you would like e-mail notification of sign off please provide e-mail address: Owner Name: r, ,,t---e tc12�--'� Owner Address: 9A--z- -e--�-- Owner Tel. No.:1/ ` -55S % ZO 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: /f , 5 DATE: 3.- 3 (- 023 PLEASE NOTE COMMENTS/CONDITIONS: {oti�a�,�o TOWN OF YARMOUTH �, _-Y�� HEALTH DEPARTMENT o:.�.. _� ��4''��=E%��� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant.• Building Site Location: (.� � �����" �" `��''� �� y�''/�?��"'Gc�� �'�`"' Proposed Improvement: f��.=�-� � �-�- �' `--� � � � � Q•�,� s di.e--,� -�Z�' piS /2 .,� �, ,�, / � � Applicant: �'i��,�-Ea,- 2 �i�-�L' TeL No.:'��„� ' � ..� � � t�-�j Address:�/�� �`Ir�a/� �� �0.�,�"��-�'�,��•�/�� Date Filed: d�r! �� �� �-1/�, **Ifyou would like e-mail notification ofsign off,please provide e-mail address: Owner Name: �i�.:',rr�� ��..-•--�'�"� � Owner Address: ��,:?,/�" G:�,�'�l�i`°�� .f`� ��' Owner T��.No.:9�i.� '�.�...���j��j .................................................................................................................................................................................................................................................................................................................................................................. 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.) I�necessary, Title 5 application signed by licensed installer with fee. ................................................................................. .. ... .................. ....................................................................... ...........:................................................:.........:..............:.........:....:.....:............................................................ REVIEWED BY: DATE: Ll ��i ' � , PLEASE NOTE COMMENTS/CONDITIONS: � . 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