HomeMy WebLinkAboutHealth Sign Off shed `, Y4.4. TOWN OF YARMOUTH
{ HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: 3 t ,,,`fc.t 0 9r;l
Proposed Improvement: i 0 14 b
F
Applicant: 1 f• .n.. Tel. No.:(.5'
Address: Date Filed:
**/fyou would like e-mail notification of sign off,please provide e-mail address::,
Owner Name:
Owner Address: 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:
(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:
DATE:
PLEASE NOTE
COMMENTS/CONDITIONS:
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