HomeMy WebLinkAbout2022 Sign off Transmittal - New 3bdrm Home ''A TOWN OF YARMOUTH
A_ HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: /Z -5-' 1 t}d ;c -' .2-4/ • spa. \A02-1,Y>6uT
-3 Proposed Improvement: /l/ C 6 dST,evC 7/6,J rj PC 1J oCAA4 f
Applicant: ()f-?4- Cl2 Tel. No.(,`A ,3g 7 _/i 35
Address: 3 3 (A-) /2„/ //)4 ,, e>247 Date Filed: 2 `zs- 2z_
**/f you would like e-mail notification of sign off please provide e-mail address:
Owner Name:
Owner Address: 3 am/ y/IM. ✓ Owner Tel. No.: 5-7},k-. SS - 3Y
RECEIVED
RESIDENTIAL AND/OR COMMERCIAL BUILDING
MAY 2 3 2022
HEALTH DEPT.
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: ' D
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✓ PLEASE NOTE
COMMENTS/CONDITIONS:
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DONALD I. MEYER
Pro fissional Building Designer
KO. Box w
71 smy.urh,nums64
{S09) 9943296