HomeMy WebLinkAbouthealth sign off 86222 p
r,Y TOWN OF YARMOUTH
;, r HEALTH DEPARTMENT
`� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: 9/ i 7 WOCIk Ct/A Ainc)(/ ig/i- /
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Proposed Improvement: 64ii•e/I "e)(t Ll h jaaj,e Gt/ir7bccJ /:7)7 Q,?
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Applicant: /'U 6/2-o ,i,e,...) ,/--,_ 51Xit' b' C2G1o`lrI'1 Tel. No. (Of' 1P/:"* CA
Address: 9 Y -e_ o41/4trino,ii-1---- 4/T Date Filed: 02rft,Q
**If you would like e-mail notification of sign off,please provide e-mail address:,EjG hi 000/.. Vc& d�,ra i �,60rh
Owner Name: , .. ` �✓h) lAe. (�7Oa i�
Owner Address: q,0 7 leolik y/Ytijt1/L f 71- Owner Tel. No.: ( ef7-- I fr
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:
Site Plan showing existing buildings, water line location,
and septic system location;
E :i:'A :: (2.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
Note: Floor plans not required for decks, sheds, windows, roofing;
HEALTH.DEPT. If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: ( DATE: g - a :. -)--.?-.
-. ,,, PLEASE1NOT
COMMENTS/CONNTIONS:
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