HomeMy WebLinkAboutHealth Sign-offTOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location:Cov
Proposed Improvement:
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Address:\\13 rnoq\L
**Ifyou would lilce e-mail nori/ication of sign ofi, please provide e-mail address
OwnerName:
Date Filed:gl(,'t \+'aceg
Owner Address:Cot)Owner Tel. No.: BcA.z4l.
HEALTH DEPARTMENT:
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APR 1 4 ?CI?3
HEALTH DEPT.
RESIDENTIAL AND/OR COMMERCIAL BUILDING
Determines compliance to state and Town Regulations; i.e., RequirementsFor Septage Disposal and other public Health Activities.
Please submit three (3) copies of plans, to include:(i.) site Plan shorving eiisting buildings, water line location,
and septic system location;.). Floor plan labeling ALL rooms within building
(all existing and proposed) -
Note: Floor plans not requiredfor decks, sheds, windows, rooftngi(3.) If necessary, Tifle 5 apprication signed by licensed installerwith fee.
REVIEWED BY:
PLEASE NOTE
DATE: $"
COMMENTS/CONDITIONS:
Applicant: TqgLrqne L-a;lel Tel. No.: soB-zc+r<1=o
3 Covey Drive - Yarmouth, IvIA
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To be completed by Applicant:
Building Site
Proposed Lnprovement:
dt
Address
**Ifyou would like e-mair notification of sign off, prease provide e-mair
OwnerName:
Owner Address:7
PERMIT APPLICATION SIGN oFF TRANSMITTAL qHiETH DEPT.
$Lb?-aliD77
>0r
Tel. No.: m-)
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TOWI\ OF YARMOUTH
IIEALTII DEPARTMENT
DATE:
PLEASE NOTE
RECEIVED
tlAY 16 2023
r"t.No.W
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IIEALTH DEPARTMENT: Determines compliance to state anl.Tgyr Regulations; i.e., RequirementsFor Septage Disposal and other pubric Heatth.i,"iiuiti.r.
Please submit three (3) copies of prans, to include:(1.) site plan showing existing [uftings, water line rocation,and septic system location;Q) Floor pto labering ALL rooms within building(all existing and p"oposed; _
Note: Froor prans not requiredfor decks, sheds, windows, rooftngi(3.) rf necessary, Title s appricauon signed by licensed instarlerwith fee.
REVIEWED BY:
COMMENTS/CONDITIONS
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