HomeMy WebLinkAbout2022 Sign of Transmitta - Basement Remodel r401-..Y46.
TOWN OF YARMOUTH
c HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: ( 43 -((" 0 __.
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Proposed Improvement: .. :s3 �v t" Q 'viler 1--
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Applicant: TaMe TMJ(\'vl ' Tel. No.: /4'Q)% -75'10
Address: (.Si(- `. 1J t\DC-k 2. K Date Filed: 'I '3 l- JC)a
**If you would like e-mail notification of sign off,please provide e-mail address: Je1AOt �J�r r\w . i\sc
Owner Name: -;.`*...\if,—) 'S-:: SNS-k- .1 1-'1\-1\1.) (-)
Owner Address: -t &3-ii NC 00_, \<„ Owner Tel. No.: 11 - (qt -15+.
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: J DATE: /
PLEASE NOTE
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