HomeMy WebLinkAbout2021 Sign Off Transmittal - Open Concept Remodel � TOWN OF YARMOUTH
°: HEALTH DEPARTMENT
S 44,1V.
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: gOr/c tO 14/0"(1
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Proposed Improvement: /c icxi ,7 ty'!► s, h/9 (1/
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Applicant: 641/ -401 Tel. No.:
Address: j? .r y > dl fi Date Filed: /,.)
**lfyou would like e-mail notification ofsignoffplease provide e-mail address:
Owner Name: �� l� 6-4.4
Owner Address: �7A' // ��, ,44;r--1Owner Tel. No.: 1:1
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: , DATE: ! ( . l '
PLEASE NOTE
COMMENTS/CONDITIONS:
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