HomeMy WebLinkAbout2022 Sign off Transmittal - Basement Remodel °e.. ^s'� TOWN OF YARMOUTH
HEALTH DEPARTMENT
� �• PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: (; Out 01 . (-Le 700� 1
Proposed Improvement: PNQ ,,nr�l{Q � (� 14wutiv 1 i 4 a i fi,j11
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Applicant: C.9 c, 11)-)7 11)-)7 ( r) Tel. No.: (1 (' zto5-O?DC
Address: lq g.ct AAA 01(, 6 9 Date Filed: 0///Z?
**If you would like e-mail notification of sign off please provide e-mail address:
Owner Name: S���i Sitta Pf )2t,,tiQ)
Owner Address: Owner Tel. No.: 5 -z L( -377
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: / d� `
PLEASE NOTE
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CONCRETE FOUNDATION WALL
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6'- 10"
5EFTIC PIPE
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XISTING BASEMENT PLAN
CALE: 1/4"= 1'-0"NORTH
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- EXISTING WALL TO BE REMOVED
SLAB ON GRADE
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- EX15TING WALL TO REMAIN
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