HomeMy WebLinkAboutHealth sign off 4/24/23TOWN OF YARMOUTH
' HEALTH DEPARTMENT
''• PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by ,4pplicant.
Building Site Location: rr, N14 , OZ./- 73
Proposed Improvement:
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Applicant: - S-T'4r'-� 3YU $ Z Z 13 (,�,
Tel. No.:
Address: O� Sew, t,�} LiMd� %Vj dZ47- Date Filed:
**lfyou would like e-mail notification ofsign Off, please provide e-mail address:
Owner Name: ,4 f V *:6-Z.4
Owner Address: cAy-l�t vvtI n-c G ' , Owner Tel. No.:
PESIDENTIA.L 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 fine location,
RECEIVEDand septic system location;
APR Q 4 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 S application signed by licensed installer
with fee.
REVIEWED BY: n k- DATE:
PLEASE NOTE
COMMENTS/CONDITIONS: