HomeMy WebLinkAbout2022 -Sign Off Transmitall - Adult Bar Pool -, ----..ww,-,----
,..„‘-..Y4 TOWN OF YARMOUTH
451
HEALTH DEPARTMENT
S' ,_ 4.4,t4 I
- `` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: 3---/eo/& in, Ls-/- ac �G+vr"1ov`
Proposed Improvement: 4,61/- (.6A v ►Ou I
Applicant: 446-74 L al,- o. :5-1C . Tel. No.: ...5748-V,2- 05-50
Address: c'/ 6,,e4,74 `.c..4s4,-rr �. //0-1...-Ii /4* Date Filed: .S-/6-ZozL
**Ifyou would like e-mail notification of sign off please provide e-mail address:
Owner Name: ..�o-e 04A✓r at r►1�
Owner Address: 57g 144.,4 S+. M5/ /40te'.�uAL Owner Tel. No.: 927 -,? ..57- 5z14,1-
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
'th fee.
REVIEWED BY: S' ( - )°, �.
/�� DATE:
PLiASE NOTE
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