HomeMy WebLinkAboutBoard of Health sign off 090622 4 '``' TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 9 C - L-4\ Q C r�
Proposed Improvement: f dA/i\� 1/� b �, S 1,e
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Applicant: *1 1' \ C{,M co;v`
� Tel. No.: � 7 g 03 2�7 f
• Address: \ l i C . ry �,� ``4 r me,,, y'�n Date Filed:
**If you would like e-mail notification of sips off,please provide e-mail address:
Owner Name: .rJ C \
Owner Address: + t,2 (1, J `y J lr ti f\ Owner Tel. No.: (> J 7 g0, c)1
• 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.
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REVIEWED BY: DATE: Cis - C ))-; µw
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COMMENTS/COND 'PIONS: PLEASE NOTE
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