HomeMy WebLinkAbout2022 Sign off Transmittal - Triplex to a Duplex Jt-XitlY TOWN OF YARMOUTH
ta HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: 32 LAz,.f1 �D (Al Xi r'via a/I V y
1<e ,/,-, c.re G l c "
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Proposed Im roveme_nt: G h h,f,,,,,� ,1,
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Applicant: f�o y,✓ f3 7 Tel. No.: $o8 "�� 7e1
Address: - c'/ "-a� lz, 17 t r iy r ev} An Date Filed: 3 -PI - 27.
**If you would like e-mail notification of sign off,please provide e-mail address: ,u q.,,!oa/t Si',.',a P S r�rs n.I,c.,n
Owner Name: '(;1./0 Gej,i/her 1'-27
Owner Address: 1rn 13 or 7 eew.f riz1./ice Ann. ',"Z C 5 i? Owner Tel. No.: 50g- p / 0
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,
RECEIVED and septic system location;
(2.) Floor plan labeling ALL rooms within building
MAR 14 2022 (all existing and proposed) -
Note: Floor plans not required for decks, sheds, windows, roofing;
HEALTH DEPT. (3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: Ping--t---
DATE: — 4-7— •
PLEASE NOTE
COMMENTS/CONDITIONS:
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