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HomeMy WebLinkAbout2022 Sign off Transmittal - Basement Renovation & 1st Fl bath Ya:Y10ydir TOWN OF YARMOUTH '�'4cr HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicant: '�,' // Building Site Location: rh l/ 1-4 /6 ( ,41 f - Ly4, o cr(E c -i vi - Proposed Improvement: ts( f - z .- i.i .-c ort {2t'N00k Ot.--) 1, } s i--(L. 1 'Evtet I C.-y %ANA IA)illi• t12_ awl-(.( 1- L V*D/1,-( g_e*---7 Applicant: SW-14-14-1 Int ,..(--4. ..0 Tel. No.: 8-3--C .'"-...c--2 . .3 Address:r� C 1.i0(\ic tfrC ,i) A-- 6/lc-vs H--A-4,--? eli Date Filed: 77...T17 -.7_ **If you would like e-mail notification of sign off please provide e-mail address: Owner Name: ;j/G/(-) / J -VLA- v Owner Address:/ r H(61 0 CJ� V.-0 u{1/2440(..it A Owner Tel. No.: ,03-3-0T5Z 33 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: (/1- \---/ DATE: /'/ S - ).-2, I PLEASE NOTE COMMENTS/CONDITIONS,: _ 0L..5t t� 1 ,c ` 4 ( 4 '.- ) � �t/'d S -'r`i 0 c.7-(76(..)p I IMP UP Q Da14.‘, ' I...'i... 1 rk,.... tli „,,,. Ilvilivz . . " / % '1 .'1 ..,._ . A El i ----, 11 li M ' I../ g c:., x ‘........_. i 1 . 1 — 1 /4 ,zt!.... btu e. 9 . ( 2. =c .. � O c Or � X 1'I en, Z In \g -A Z” l y r. N i QC A. t C \‘°- ' ‘Ite=0 "-----_..0 t L �, 0 " F �. CV w 1 CV eLg o Ng Alli c 11 • F v Q = ce 1 -('-'s ="Ix 1 m e ii '`, ' i • 1--Ti-' t. uu:6:,0- ,. - `4 _ cz. — . ,,.- ,:., -.ice. 5 . L!JiLJ ....... 3„..). ‘ 7•4 VJ r .E 4'© i yrid e f' F } a y# , k ' 6 A1� r ,� 4 i \ _ ♦ 4 IN cz APR; X022 (711 �. HEALTH DEPT,