HomeMy WebLinkAbout2023 Sign off Transmittal - Addition 1-4k,,,, TOWN OF YARMOUTH
. 4 HEALTH DEPARTMENT
'�• `� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant.
Buildin Site Location: e g 6,74 `T j �/ JQ(,.7 I 4r/rial /i',
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Proposed Improvement: 5 -4/ ca.cidie,in p_G; S,47 prAe44-e,
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Applicant: S Q S, /Vt Q.S Tel. No.: - I - 2- 0662
Address: N �uSSe/ `� Jjuifet r C41g0" /, IA G/frU Date Filed: /
**If you would like e-mail notification of sign off, please provide e-mail address: S 4r h12. , Za//4e9 Co/YI C(9,4e"
Owner Name: Si5� itl ail/kid'
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Owner Address: `Y / u S Oil /-An-e— 44 Let /fri Owner Tel. No.: /-36?- �--()66
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;
DEC ( 3 2022 (2.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
HEAL T: ! - Note: Floor plans not required for decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY.-t_4../r-goCt -/e• � (�yJ DATE: - /�/' 2
PLEASE NOTE
COMMENTS/CONDITIONS: /' r
AcJ d i i, ..Tv 6-y,,ia. —