HomeMy WebLinkAbout2022 - Sign off Transmittal - Kiddie Pool / Activity Pool r4.0-.:.,�,t, TOWN OF YARMOUTH
oi°; HEALTH DEPARTMENT
!,4,,,`• . PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: 57a ioa'✓t S -/- /Ale 34- "e ev )4A
j
Proposed Improvement: �:, ;Go?or? ?mlS�✓ u i
Applicant: 0 ,,, / g LI (fp . 6-_ Tel. No.: 538-5/31-- 053O
Address:,,2 t{ 6...e,:1-
%JQs-kr A e( Lt,,,61, M '- Date Filed: 5---/6-74)11_
**/fyou would like e-mail notification of sign off please provide e-mail address:
Owner Name: Tae- tnLv rck. yin cam.
Owner Address: 5)8 f ia/.4 S! �es-7Y D u 7/'^— Owner Tel. No.: 7-78-.?137 5 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,
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.
2) . 4
REVIEWED BY: DATE: S — 1 ; ?. 0..)-. .
PLEASE NOTE
COMMENTS/CONDITIONS: n �(
3� I It V t Sr c'I 13 ( 4 --0 .:fi.-Cf‘ S-- 1 )-— d U)'-1.