HomeMy WebLinkAbout2022 Sign off Transmittal - Garage Conversion to living room 1' ''4r TOWN OF YARMOUTH
c HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: 565 cb(- r
Proposed Improvement: „kir('�-, U 1v; ti `vvl . 'kJ-)�
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Applicant: }tE eC7cC Tel. No.: &k" 7x233
Address: '(ristt CL%. Y-«'L‘(4).A. wt (.0-6-7. Date Filed: 5127/-Z?_
If you would like e-mail notification of sign off please provide a-mail address: 01)
Owner Name: Lk)019.A.
Owner Address: 3A Owner Tel. No.: (cap sa-7633
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,
_ :IOJLD and septic system location;
(2.) Floor plan labeling ALL rooms within building
MAY 2 1 2022 (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.
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REVIEWED BY: DATE: -G
PLEASE NOTE
COMMENTS/CONDVIONS:
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