HomeMy WebLinkAboutHealth sign off 10/7/22TOWN OF YARMOUTH
HEALTH DEPARTMENT
''�•` PERMIT APPLICATION SIGN OFF TRANSMITTAL S
7o he completed by Applicant:
Building Site Location: (,CQ 1s'e �� ,Q
Proposed Improvement:
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Applicant: Q II,- ^ W M
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RECEIVED
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OCT 112022
BUILDING DEPARTMENT
By --
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C�' `� 1 (a U l iz.& V o w t
Tel. No.: loll �7 v �a31
Address: I Y. �, . Eh �"A U��by Date Filed: � d•3a
"If you would like e-mail notification of sign off, please provide e-mail address: r j .J ` \ a q �a A
Owner Name: n.-,C I\
t
Owner Address: E `� oe kttF JM, Iv A o �.t. Owner Tel. No.: �(I `t 7 o -7� 31
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,
and septic system location;
(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 5 application signed by licensed installer
with fee.
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REVIEWED BY: DATE:
PLEASE NOTE
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