HomeMy WebLinkAbout2023 Sign off Transmittal - Demo & Replace ov:Ygk TOWN OF YARMOUTH
1 ,:-- '` `,o HEALTH DEPARTMENT
j'',"``� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
BuildingSite Location:
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Proposed Improvement: 7j--,77_52-s-vNi_ke,..),\A_ ,,� )lam, „
Applicant: i NA—D-2_e/, 0---- Tel. No.:- ); f'--.aj
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**If you would like e-mail notification of sign off please provide e-mail address:
Owner Name:
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Owner Address: \ Owner Tel No. ( 7-5 c2-- 3i
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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,
L "'". , 7 °� I and septic system location;
M r2023 (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 c 1,,ivs_., „vy.4�, DATE: �� -al1�
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COMMENTS/CONDITIONS: (a , PLEASE NOTE
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