HomeMy WebLinkAboutImage_002_Wed_May_17_2023_12-56-24TOWI\ OF YARMOUTH
IIEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site 3B- T -fu,.- 1/lla7* K"4.!
Proposed Improvement: Ut' 1 )z';frt"t c1 New
Applicant:(rok;,k t l+bun Tel. No.:3s= ( 7 o'7
Address tl L-{rr./ XryET rb,s 44 azcyz Dateqiled: y'?4 Y 8, 2a23(,lr
rllfyou would lilce e-mail notilication of sign off, please provide e-mailaddress, f4/m*/a^t /1LG <2+114./ .<t +t
&<POwnerName: Sl, ' ,\-rL g1 /-t*
4*-r Owner Tel. No.: 5
DATE:
Owner Address:
REVIEWED BY:
.s So-u &on *-*c
PLEASE NOTE
.-732
HEALTH DEPARTMENT: Determines compliance to state and Town Regulations; i.e., RequirementsFor septage Disposal and other public Health.A.ctivities.
Please submit three (3) copies of plans, to include:(1.) site Plan showing existing buiidings, water line location,and septic system location;Q) Floor plan labeling ALL rooms within building(all existing and proposed) _
Note: Floorphns not reqairedfor decles, sheds, windows, roofingl(3.) If necessary, Tifle 5 application signed by licensed installerwith fee.
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