HomeMy WebLinkAbout2022 Sign off Transmittal - Suite 2 - Use and Occupancy S YAk TOWN OF YARMOUTH
HEALTH DEPARTMENT
•
�• PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant.
Building Site Location: � ? //16tA/ V /
Proposed Improvement: �c 1'�-- t t v Z ! (( C
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Applicant: Lct pl.— 6)/ / t` Tel. No.: -50?)-- 77 Y C >C
Address: c/ )'I'74�� f) /2c /46;ei % S Date Filed: '3-
**/fyou would like e-mail notification of sign off,please provide e-mail address:
Owner Name: 'cm
Owner Address: Owner Tel. No.:(/,i/
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. i):2A / DATE: �� /
I
PLEASE NOTE
COMMENTS/CONDITIONS:
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