HomeMy WebLinkAboutHealth sign off 4/20/23of Y/A k
To he completed by Applicant:
Building Site Location:
Proposed Improvement:
TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITT
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Applicant:Tel. No
I
REGElVED
APR 2 0 2023
Bu DEPARTMENT
Address: e : ; Date Filed:
"Ifyou would like e-mail notificatioi? ofsipi off, pleaseprovide e-mail address:
Owner Name: 6
Owner Address: S �� L (_ r7 �, Owner Tel. No.:
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:
(L) 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, n4ndotivs, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
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REVIEWED DATE:
PLEASE NOTE
COMMENTS/CONDITIONS: