HomeMy WebLinkAbout2021 Sign Off Transmittal -Sheet Rock Storage Room in Basement TOWN OF YARMOUTH
HEALTH DEPARTMENT
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''�• '� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
(-4.
Building Site Location: /(.)``� �� �� �u � u V771
Proposed Improvement: 7 ( . X11.1--ter< Lc-7/
/N /1-5-6744 ?- - '' `,
Applicant: n R (3 Tel. No.:6( 7-32-d
Address: /L7'$ ST • (ñ '
Date Filed: ( 1 2
**If you would like e-mail notification of sign off,please provide e-mail address:
Owner Name: D {r..(Ni` ) S I`YJ
Owner Address: Owner Tel. No(( 7 —3 z Z
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: 1,1 DATE: ' '
PLEASE NOTE
COMMENTS/CONDITIONS:
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