HomeMy WebLinkAboutHealth sign off 5/15/23TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location:
Proposed Improvement:
Applicant:
Tel. No. 3/ Z-S2M/
11
Address: G%� IyL 1�.�
' 171. A-1A4 _ .IS, lArl ll Date Filed:
**lf you would like e-mail notification of sign off, please provide e-mail address:
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Owner Name: f /G-k J A7V [)
Owner Address: �P/)r,'q /P��i 4-1, - 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
APB (all existing and proposed) —
?QZ Note: Floor plans not required for decks, sheds, windows, roofing;
+ LPH O pr (3.) If necessary, Title 5 application signed by licensed installer
with fee.
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REVIEWED BY: I DATE: J /5
PLEASE NOTE
COMMENTS/CONDITIONS: