HomeMy WebLinkAbout2021 Sign off Transmittal - Detached Garage TOWN OF YARMOUTH
.° HEALTH DEPARTMENT
• ''���`` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant.
Building Site Location: q PO • DEC 01 2021
HEALTH DEPT.
Proposed Improvement: (7_-.4 ASNCvc i- X a
Applicant: � C � �fC Tel. No.: - 13a - �O
Address: S`� QveQvk hv�� Date Filed: WI 102 1
**If you would like e-mail notification of sign off please provide e-mail address:
Owner Name: 3(nMe S c <v+lcmA
Owner Address: .e4‘,‘ 1234 P, Owner Tel. No.: '7 41:531-‘04,g
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 � , DATE: t
PLEASE NOTE
COMMENTS/CONDITIONS:
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