HomeMy WebLinkAboutHealth sign off 6/12/23 A.:7444;4_ TOWN OF YARMOUTH
HEALTH DEPARTMENT
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PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
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To be completed by Applicant:
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Building Site Site Location: /2
Proposed Improvement: ' -L' ^ .
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Applicant: /4/674,5.`,"4,44 4--2,/16,ec- e1/ Tel.No.: ' _
Address: /57 - ml
5 724 Date Filed:.....4 /Z.,- 24'23
**If you would like e-mail notification of sign off please provide e-mail address: IC /r4t.5/14 cr,,,,,,teai
Owner Name: le,,,,i- ._.9, A:e rro
Owner Address: /Z e) /)--ke S- ,f-cou7/4 ST/ Owner Tel.No.:
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RESIDENTIAL AND/OR COMMERCIAL BUILDING
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HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations;i.e.,Requirements For Septage Septage Disposal and other Public Health Activities.
Please submit three(3)copies of plans,to include:
RECEIVED (1.) Site Plan showing existing buildings,water line location,
and septic system location;
MAY 1 0 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.
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REVIEWED BY.
DATE: g -6) -02,3
PLEASE NOTE
COMMENTS/CO DITIONS:e A...._ ... ___
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