HomeMy WebLinkAbout2023 Sign off Transmittal - Front Entrance Renovation o. TOWN OF YARMOUTH
4' HEALTH DEPARTMENT
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Y` `1"==``'� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: j 73 ) /274'1 Zg> A.) ,riitg~,64 y 3
Proposed Improvement: -y ,/° Ca yuj?Vg- f_t .?') a C
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Applicant: �/ 6,,,,y4., �7 / 1'k°2 Tel. No.:(774)247-6)4'jl
Address: C 75) /7/T 2-j 70 . yG0A/n, , fr �2 G7_3 Date Filed: ?U/ D 3
**If you would like e-mail notification of sign off please provide e-mail address:
Owner Name: I MP, 4-CAJ-1- ' ,fiWi;).& - M,(__
Owner Address: " call/e A/JC 1 P
Owner Tel. No.:OM 1{1-6 2/3-7
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:. ci\,,,--,-, c,, DATE: 3-�0 3
PLEASE NOTE
COMMENTS/CONDITIONS:
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