HomeMy WebLinkAbout2023 Sign off Transmittal - Use & Occ TOWN OF YARMOUTH
a HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant: A �r�
Building Site Location: 'aco A - •a� c_� (,L Q( `•l 1-
Proposed Improvement: lViii.,0►`d
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A licant ���� \-14jAk, ee tve� Tel. No.:53A --+ — oZ
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Address: \ � 4\v`"0-` Glr14‘C ‘-tk ,04.5- Date Filed: 2 5 \ 2
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**If you would like e-mail notification of sign off,please provide e-mail address: .V.Sk'C VV 1\,
Owner Name: O\AO '\ 1 1•)61 `
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Owner Address: \ZL; -- `Q.\- `�_ �. Y1�� -` 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:
RECEIVED (1.) Site Plan showing existing buildings, water line location,
and septic system location;
IO?' (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: �,��� DATE: E -( s
PLEASE NOTE
COMMENTS/CONDITIONS:
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