HomeMy WebLinkAboutHealth sign off 5/18/23o=YA TOWN OF YARMOUTH
` HEALTH DEPARTMENT
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PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
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To be completed by Applicant:
Building Site Location: 2 Ca.x��.s
Proposed Improvement: )( Lj q'
Applicant: Tel. No.: � Z'Z-" 7327)
Address: 14 Date Filed: L o Z
**Ifyou would like e-mail notification ofsign off, please provide e-mail address:
Owner Name:
r o s,
Owner Address: �� 1 �11-, S� 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.
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Please submit three (3) copies of plans, to include:
(1.) Site Plan showing existing buildings, water line location,
2 0 2023 and septic system location;
�EpT (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 S application signed by licensed installer
with fee.
REVIEWED BY f DATE: " / 'd_2�
`�— PLEASE NOTE
COMMENTS/CONDITIONS: