HomeMy WebLinkAboutHealth signoff 4/4/23 ot- k TOWN OF YARMOUTH
"° HEALTH DEPARTMENT
o ` -
P,4v..' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: /-7 crp Cic/ 1a-c.
/-- K.iovouPli
Proposed ImprovemLLent: Rfr2� �/0 . 6. -Ce `� j)S 4, �/ a71
/S Tca:' 74Ao CL e -Vi O O e_k/Sf, r5'//J c.1-4 _
Applicant: C/r25- 4// ,P_41.�41 //�e Tel. No.:67 0p�S /-5 7 90
twot) . , �o, P4- L l3 ��
Address: 6 Pre PL S - Date Filed: Y /
**If you wou d like e-mail notification of sign off,please provide e-mail address: Pi 1 I pima / ne_ o COyv
Owner Name: Cie--5-f // . - C�iVEX/ v�
Owner Address: 6 j p! - Owner Tel. No.:(70 o Y--- 'o
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.
-s
REVIEWED BY: C.,-f—Ac. CCt2 - = DATE: �/- e7 c .
PLEASE NOTE r
COMMENTS/CONDITIONS: 4
L , r....m. ".*