HomeMy WebLinkAbout2022 Sign Off Transmittal - New Bathrooms near Lazy River ON TOWN OF YARMOUTH
r HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: 1/8 70a/r7 S� l��S / �h
Proposed Improvement: /k4,), i / ✓00,4 S , iv
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Applicant: G'/,, f C Zi (2 Tel. No.: S43-y3 05`30
Address: `/ veti/ /6454,4 7 Date Filed: '%/,677 Z
**lfyou would like e-mail notification of sign off please provide e-mail address:
Owner Name: J ��� ��i 1-12"1at 4-z.,
Owner Address: S /'1/1�,.,:ri S71 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:
(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
COMMENTS/CONDITIONS: