HomeMy WebLinkAboutHealth sign off 12/19/22TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: /0 -s-
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Proposed Improvement: `� „�< <` �, �`i / I j �_ �l �% vyl /U p u I
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Applicant: ��� ='( I Tel. No.:
Address:
%A(, Date Filed: ; L _ k - Z�
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Owner Name: 411477 I-e Ly
Owner Address: _1CG E �t `�✓ I Owner Tel. No.:
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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,
REUZIVED and septic system location;
DEC O 2022 (2.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
HEAl.T 1-1 D -PT. Note: Floor plans not required for decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: r ' c :- ? DATE: —12 -
PLEASE NOTE
COMMENTS/CONDITIONS:
4
WATER DEPARTMENT
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BUILDING 11:1011'1' APPLIC:k•I•IO\ I OR
"'ATER DEPARTMENT SIGN OFF
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