HomeMy WebLinkAbout2022 Sign off Transmittal - Remodel Basement TOWN OF YARMOUTH
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HEALTH DEPARTMENT } FEB 14 2022
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET T
To he completed by Applicant:
Building Site Location: // `� '� t- � SLC
Proposed Improvement: # �� £ore 1 . e Jc �`' �'L't h %� ' ' ' 4 h
>'G (7 Le, ;h Gr o ("4" ve de)
Applicant: C �� .S /p4`!�! C L �/J Tel. Na: 5O .34 48/r
Address: (✓or sr-"47 Date Filed: 02 "/ ".Z
**/fyou would like e-mail notification of sign off please provide e-mail address:
E-Owner Name: ` % 2 h - ( / f G
Owner Address: /1 4 �4 e �� Owner Tel. No.: Y/Y`l YraV .
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: DATE: aA
PLEASE NOTE
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