HomeMy WebLinkAbout2022 Sign Off Transmittal - Bedroom Conversion ot.f 4, TOWN OF YARMOUTH reb i ?
4:° HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: tomb 5.,11 92A4
Proposed Improvement: . .
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Applicant: pc,u,,3 1- ,ct,uvn4Y. Tel. No.: :8-gp-'7 16,6
Address: lei t 9v t e\,,,5 7- SA_4-,..,-‘- , -11, Fn s4a,n , n`rt Date Filed: „2-l g-,2
**Ifyou would like e-mail notification of sign off please provide e-mail address: br-0 s.1 d 0 c•,,,c,- � v T}
Owner Name: Pc\,C ,,,,,,6 sl„,.v v,o,r%_ v jeac+&c
Owner Address: 1 1 co y 9.a Owner Tel. No.: 6,19• Ss? - 6(7 3
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.
REVIEWED BY: 5,1 ,i-(---ei /4-,4-,i , DATE: /1 a j,7�2z_
PLEASE NOTE
COMMENTS/CONDITIONS:
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