2023 Sign off Transmittal - 2 room addition .ot Y` ,y TOWN OF YARMOUTH
$'' : .c HEALTH DEPARTMENT
-„`t PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant: //
Building Site Location: 6 L( f�vlct, (.✓t, T. yCt.n44. c/71-4
Proposed Improvement: B✓:10( c; a r ida.71, do-4 a.re on e. ✓�i� tt
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Applicant: cJ XCoc Tel. No.: 77q-357s'-66.3a
Address: P. b. 6OX 3` 9 Y OU ad( 714rl- O0607S— Date Filed: /1/40 3
**If you would like e-mail notification of sign off,please provide e-mail address: IC�QCO b$ 7f ,,AGt oo, c Owl
Owner Name: Marl
LO✓ 1 17a 4h mi
Owner Address: (off'( ((oh? /e , S' y1 x,4t0a/l In Owner Tel. No.:
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
JAN 12 2023 (all existing and proposed) -
Note:Floor plans not required for decks,sheds, windows,roofing;
HEALTH DEPT. (3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: DATE: I //7/01 3
PLEASE NOTE
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