HomeMy WebLinkAbout2022 Sign off Transmittal - Gerage Conversion to Living Room � TOWN OF YARMOUTH
3 HEALTH DEPARTMENT
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'�• • PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location:
Proposed Improvement:
Applicant: )tg-UI;0 Tel. No.:77V 212 "-O-i-?3
Address: ?(7 (P Pcr Date Filed: 1'/y/.2H?•22-
**Ifyou would like e-mail notification of sign off please provide e-mail address:
Owner Name: •ie.", y i & 1
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Owner Address: ? 1uc l��,,��� lar It! r t Owner Tel. No.:77%- Yri 224-)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: rl DATE: ///:), L
PLEASE NOTE
COMMENTS/CONDITIONS:
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HEALTH DEPT.
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