HomeMy WebLinkAbout2023 Sign off Transmittal - Unit 67 Exterior Remodel q'.— k TOWN OF YARMOUTH
i s �.3''''' _lk, HEALTH DEPARTMENT
RECEIVED
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p_., PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEpT 1 7 2023
To be completed by Applicant: HEALTH DEPT.
Building Site Location: c' 5(7, t 5i-, 1-ou�(... (�C,f h�o-IL �� c L(4�
Proposed Improvement: c�d w ci le, .- cuv d Fcti.+1l- S ikt_ cF
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Applicant: C -- `avt 1,'14c%L`, Tel. No.: 544- a- 51
Address: g ?Sr416.e4 ‹J Cevri-r vile_ /W.4 4z.43z. Date Filed: 5//0_3
**If you would like e-mail notification of sign off please provide e-mail address:_Paw.Cart 4 c•..c$tc+\gI e 9(v2EMt•c.ort
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Owner Name: „..)vviv- re_ COGSiA.L\
Owner Address: deg Sv,,1-1k- 5 5e34, (.chrwtcul/ Owner Tel. No.: 6'r4P34-7Z 0j—
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: 7DATE: '.:71- 2
PLEASE NOTE
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