HomeMy WebLinkAbout2022 Sign off Transmittal - Retail Flower Shop - Use & Occupancy TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
2W+PrBuilding Site Location: 23 Whtk'S U nck SOS- u\ctit\O --- MM 02W-1-
Proposed
oposed Improvement: vikai1 'UOv 5
Applicant: 4z\1(cL7bC1(land.0 -aPt StkaRIctUt Cit ""'\`.(Tel. Na.: 11i+ 26-1 • OO
Address: 23 Wn� � PCS- MDate Filed:
**Ifyou would like e-mail notification of sign off,please provide e-mail address: .Corn
Owner Name: CSi4\0.-:bb CA(\b6
Owner Address: (12 3614)--GoL LA\ H.cd s\ 01Kwner Tel. No.T1 y' in •OGGC
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: / /PI�
PLEASE NOTE
COMMENTS/CONDITIONS:
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