HomeMy WebLinkAbout2022 Sign Off Tranmittal - 3 Season Room TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
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Building Site Location: ( 'C7 e\ U \D- `>p )1G\Tm tz-t.J.&
Proposed Improvement: ► enc �_ � �,,Vic, �'c.Ndam. �'. A k,‘A. cam, "bile--3
Applicant:r3nTel. No.: `41st 0-
Address: L-• VG. N Dc . > r- M„ &Date Filed: ( ( 7s (,9
**/f you would like e-mail notification of sign off please provide e-mail address: W �0 aC R tv1a
Owner Name: -��c��n � �t _
Owner Address: - tom- k Po/\3 Pr . ( fv\bOwner Tel. No.:� s t a SD g 0'.3
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: % � J y, DATE: J
PLEASE NOTE
COMMENTS/CONDITIONS:
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