HomeMy WebLinkAbout2022 Sign off Transmittal TOWN OF YARMOUTH
0 HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant.
s-t-iP o -j
Building Site Location:
Proposed Improvement: .�C/ x a�a�. I t-e�� r �i 1-fes v 1 / a of Civ, w�, //
+ �of 3 a� M., \,, r ou
e c)r c i t ) )op e u i (iI/F -+ o- o o r
"� a k 8 _ 2223
Applicant: / Tel. No.: fia
(J/6U ? R1
Address: �� e ^64. °/ v R— ltA A Date Filed: t//)3/7 L-
**If you would like e-mail notification ofsi n off,please provide e-mail address:�' 4 jO ' �� • lea w //�"G" l • co
Owner Name: a/ 7
Owner Address: Owner Tel. No.:
K Gtivwu
APR 1 3 2022
RESIDENTIAL AND/OR COMMERCIAL BUILDING
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;
o_r t ' (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: I �4- �—`" DATE:
PLEASE NOTE
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