2023 Sign off Transmittal - Add screen porch, garage w/ Master Bedroom TOWN OF YARMOUTH
. HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: 4 27�(2)IerVICOCZ3:1 -'t 5 \/(), 'NO } Ab.
Proposed Improvement: afA4 9tyfeeri efe oyi C�
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Applicant: a1PVDran ��/`��� lit Tel. No.47I Z ► bera9
Address: - 2�L� , , t R). Date Filed: .1 L 7 . 22;
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"If you would like e-mail notification of sign off please provide e-mail address: i� �! ubL,lie ) .(ma,
Owner Name: 1/.avi. r2Ordvll/
Owner Address: 2? 017.\,14.22! Ziti l W‘V6304, Owner Tel. No.: rp`my
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;
JAN 6 2023 (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: DATE: I /6/1,
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P EASE NOTE
COMMENTS/CONDITIO S: -d
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