HomeMy WebLinkAbout2022 Sign off Transmittal - Finish Basement ,:,-...:4,,,,,,, TOWN OF YARMOUTH
i:741e.„ . HEALTH DEPARTMENT
'!',4c0' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: / -h DE pen celep&if l't J IA/yek-it sr,o c. l 0 4.73
Proposed Improvement: JAcorn, Zip Lay /`o e/Yl - A-se/-)-747/z
Applicant: ,o h ert e- Pu-u-La- Rini Tel. No.:-50,5-- ?5g - 0 Vg/
Address: Cas . ea-bo Ve Date Filed: D2 -p2-20z 2
**/f you would like e-mail notification of sign off please provide e-mail address: -1--h 4),./0& v;_ /az @ / C/o:„id, e D P 21
Owner Name: io her- ¢ /41-44.Ia_ /ha470
Owner Address: c'- ane ccs 6o v€ 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: ,... ..7- ✓ DATE: `-�
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PLEASE NOTE
COMMENTS/CONDITIONS:
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FEB 0 8 2022
-- ' M C7 HEALTH DEPT
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