HomeMy WebLinkAbout2023 Sign off Transmittal -Bedroom relocation .4,,, „
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�,t._Y `' TOWN OF YARMOUTH
� r HEALTH DEPARTMENT
' ,�`� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: D Civ cvi , / oa 41' e( , j
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Proposed Improvement: g_p LC G l/ VI 6 dlriv m
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Applicant: / d� 57A C0✓•E n'A /tJ/ e 4,1e Tel. No.:��I- 6�7 //�5
Address: 5— &,- .;7 /t?a/ Date Fi1ed:� e f2 ZCZ3
**If you would like e-mail notification of sign off please provide e-mail address:
Owner Name: 5c4ovtd a S a v'v
Owner Address: Owner Tel. No.:
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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.
Please submit three (3) copies of plans, to include:
__.__.____ (1.) Site Plan showing existing buildings, water line location,
and septic system location;
JAN 12 2023 (2.) Floor plan labeling ALL rooms within building
HEALTH DEPT. (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: / 17 3
PLEASE NOTE
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