HomeMy WebLinkAboutBOH sign off 121521 .^A
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:O 'Yak' TOWN OF YARMOUTH
�� ;c HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: LO-N 2-� Zit. tCIS(,1 S�• � 1`�n &/01 RA- On I 6,Cr,7
Proposed Improvement: e(y,S\-li U ck 7-I C(ljn L Y- bdu) ,
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Applicant: 5( tit- D61 16L( eti.scirn j Tel. No.: SV1'(09(-/-gol 5
Address: .2-S-ct Gj r -- (,OeS- r (rici, V(l.i f- (7 Date Filed: 1'Z,'1 5.'Z/
**If you would like e-mail notification of sign off,please provide e-mail address: 'e)Yi (d- /lcSa d f lO i 1 J C )St ry15r.14
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Owner Name: -)CVV& WILL( Clv S * (Y1..J
Owner Address: --e-L \1,-Q___ Owner Tel.No.: J
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.
t, Please submit three (3) copies of plans, to include:
G` ` l vi r-'& (1.) Site Plan showing existing buildings, water line location,
L L] 1 e '1O2i and septic system location;
(2.) Floor plan labeling ALL rooms within building
HEALTH DEPT. (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: . 0.A"-x7 DATE: 7' - 5- --d
PLEASE NOTE
COMMENTS/CONDITIONS: