HomeMy WebLinkAbout2022 Sign off Transmittal - Convert Garage into Family Room oi. TOWN OF YARMOUTH
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r HEALTH DEPARTMENT
? PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: j,'7 G.E. ( A v C
Proposed Improvement: �v•, A
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Applicant: / Tel. No.: c,Cr 22 I .' <
Address: r% K ,,, 7U r Pic . J, �,rlic�..7l� Date Filed: z / ' 2 Z
**If you would like e-mail notification of sign off please provide e-mail address:
Owner Name: J/- kJ G l-i u y
Owner Address: `:-( CI 7 e r ( i /yk 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.
REVIEWED BY: DATE: 4/1 r"—/ Z
P EASE NOTE
COMMENTS/CONDITIONS'
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