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HomeMy WebLinkAbout2023 Sign off Transmittal - Front off remodel ov:,!)-rAit TOWN OF YARMOUTH a .�j,, , ., HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: 573 j g ; ), ya-m (67% rrfrei--074 7� Proposed Improvement: G I 7 Applicant: Ma 1aC,; 60 704-7° 10-20 , D1/ Tel. No.:(774) Address: c 77, '7 �'d ' i1 Y10�� /�' G 1 2 �3 Date Filed: � �?/ **If you would like e-mail notification of sign off please provide e-mail address: Owner Name: /7z Owner Address: — 7-✓► P Z11/e Owner Tel. No.: C7 702 7 f57 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: RECEIVED (1.) Site Plan showing existing buildings, water line location, and septic system location; NAY 0 9 2023 (2.) Floor plan labeling ALL rooms within building (all existing and proposed)— HEALTH DEPT. Note:Floor plans not required for decks,sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: C,✓).-4:, DATE: l ) 3 PLEASE NOTE COMMENTS/CONDITIONS: !, ,:t,.:,,,,:,,,,,,,j,,,;,•:,li.,..;, i:::,..,II, :..,, „ ,,,,,,,,,,,,,,,,,,,,,,,:„;,,,,,,,,;!ittOP „„,,454,454,,,%•50 • ,., „:4154!,t 4 5,,,,7., .,,:. .5,, i„.,,,,!,4,a5t;;04,15.1!.r., rf,%,?.igr.%)''';••.4 ,, • -' ,41-,:• 0,', . ,6441‘,*4 , ;-• ,- ' . 4 -• f.- .,.t. '...:.::;:':'''!I' ' ,•.:„54., !•.,J.-"::A,,,?.1 :,,..:,,-..;',, ;,,,y,,...-gy...,•:,•;,50144";,' VArt*440 • -, „,. :,••-•J,:•,, •--:.'ir'• ' 4-4; ' .:::;-,, i :,,.,.:',-tt'-'," :"-rtf,,,, ,',,„-;;;; „fe?„,iyinfftr , ,...;,,A;"itti,.,',07 *OP,.6,6riry,,r,Irrt 6 14 6666 6'6 .6 j'644. i ,.. 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