HomeMy WebLinkAbout2023 Sign off Transmittal - Enclose Porch TOWN OF YARMOUTH
HEALTH DEPARTMENT
= PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: , V.\ t
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Propose provement: �7� ►�, A �Q,- l r- 'r7 L i
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Applicant: 5l-AN) P 1 $ l?J t t)Y7 Tel. No.: 5 ZF) b �l 7 L 9
Address: e, (7 (2j()X G D-7 0, I)) L-3)--mate Filed: 'f A )—
**If you would like e-mail notification of sign off,please provide e-mail address:S IL, 2 II Or CO olr + Ciro
Owner Name: (1".A., �') Q V)
Owner Address: \Than Owner Tel.No.: d I l I4 \ 61
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.
RECEIVED Please submit three (3) copies of plans, to include:
(1.) Site Plan showing existing buildings, water line location,
APR 12 2023 and septic system location;
(2.) Floor plan labeling ALL rooms within building
HEALTH DEPT. (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: DATE: 3--i
PLEASE NOTE
COMMENTS/CONDITIONS:
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