HomeMy WebLinkAbout2022 Sign off Transmittal - Suite 1 - Use and Occupancy it
1. TOWN OF YARMOUTH
r
4,1,
C: HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant.
Building Site Location: f " (1(-.--L) 4 (
Proposed Improvement: 1 ` , f t-I Q ( _ (2)/--) z
`� C
Applicant: . � / / t I) ! Tel. No.: S v55 7
Address: , . �. �'k�i c / -; ' Date Filed: 3C' )--
**/f you would like e-mail notification of sign off, please provide e-mail address:
Owner Name: To
Owner Address: Owner Tel. No.: � a1 - 9
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.
/36 REVIEWED BY: / / ,\ / DATE: ) 12--
PLEASE NOTE
COMMENTS/CONDITIONS:
„9,4 4 ,A.£ 00,b .,0,9
„V,£
.A..p
1 „0,04
co_ H1V9 JH
A
4„0.9Z4►
o
.b
4044,2£► ... A . „0,9
4. .0014 4,,4
- A
UN= ISM
K..
0
F
\
d _.
"Ci
1-4
4,.9,Z/ 4„Z.9 °”?
/,44 ,804/ o y9 „y,01. A.9
N N
..0,b4 „81 9,17,t,
4.,9.04► . 4„Z 37I 4,.Z al.
J b.6
aDueJa}u3
/..44 .924► 0 4„9.L9► _ -
= n• o O
„0.V4 ,.81
0t7,9