HomeMy WebLinkAbout2023 Sign off Transmittal - Deck TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location:
Proposed Improvement: hi \d G. 4
)( Y (Cray�x� e l� � hc
Applicant: (et ez,.,i'f-e( Tel. No.: ;t $' 7 37 //I'7
Address: ets,,,i G L (C' (c r„Q ?(O-fmc),_i LT kickikT r /�v. G?� ? Date Filed:
**If you would like e-mail notification of sign off,please provide e-mail address:
Owner Name: � i C.—a+-ifIG;,)
r
Owner Address: S =j �,�� ,1 c4 ,iv N G ry .n ilL /114 . Owner Tel. No.: SZ) 3 737
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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.
� �. �7 � Please submit three (3) copies of plans, to include:
(1.) Site Plan showing existing buildings, water line location,
Asks 2023 and septic system location;
(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: -/c-ot 3
PLEASE NOTE
COMMENTS/CONDITIONS: -
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