HomeMy WebLinkAbout2022 Sign off Transmittal - Partial Basement `N Yi 47 TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: "/1/ . t \' a /tA' a1
Proposed Improvement: gy i t i tr
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Applicant: l_1 ZA144--(L4,41-4 t-efrk? Tel. No.:
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Address: 4 - jtl Date Filed:
**/fyou would like e-mail notification of sign off please provide e-mail address:
Owner Name:
. ,, � wStIA�►�►T` (A 'IL-
Owner
Owner Address:
��--\J P/V y Owner Tel. No.: C' -' 7671527
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:
MAY 3 1 2022 (1.) Site Plan showing existing buildings, water line location,
HEALTH DEPT. 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: , _ �! / DATE: I d\1'
PLEASE NOTE
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