HomeMy WebLinkAbout2022 Sign Off Transmittal - Finish Basement TOWN OF YARMOUTH
.�� HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant. I
Building Site Location: 3 Co 3(J � 1� Ckm-
Proposed Improvement: c ✓Gi S k r
Applicant: ZrC4,A1 -CrSc.A— Tel. No.: S� a 0/-07 a
Address: go Crowb,-y- CLW A) Date Filed: 1/4l
**Ifyou would like e-mail notification of sign off, please provide e-mail address:
Owner Name: phi adj i11‘h�
Owner Address: sf2 8 k-'Ne24 De.nvtS ry)A Owner Tel. No.: 201 & i S---)c ja
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,
Ree WED and septic system location;
APR 06 20Z2 (2.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
HEALTH DEPT. Note: Floor plans not required for decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: DATE:
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PLEASE NOTE
COMMENTS/CONDITION,
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. _____. __..._. , _ ____ _______ ______
s.40\r„, cLos-t.4. RECEIVED
APR 0 6 2022
HEALTH DEPT.
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