HomeMy WebLinkAbout2022 Sign off Transmittal - Greenhouse Renovation �o Y...17/7,4r TOWN OF YARMOUTH MAY 31 2022
3 r, HEALTH DEPARTMENT HEALTH DEPT.
''�•`� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: 't S�wtm.e.,r- 3.1'. YG:roitc .L ort.
Proposed Improvement: W i tAdaw re idtx cc,w,_QAl , Dc ' re MO Va.
G-ta sS Greer►k6tA.s.e eoo c a.d t,mi1_s 4,1_ l e renmued 0018 reelaced
Iy i ' tro.dtcv t Z Xel $4- ick bLc1li- (At 0,11 s and oi2,„Fae r'oof'
Applicant: a nn;fer --"ri-IcAF-vvlav, Srcr'4-te 14 Cul Tel. No.: 501r Z7S/- 8,765
Address: 9t ;A Si -~ eSh Yee4i„,..F& "R,,,l-, NA cge,75 Date Filed: .3i
**/fyou would like e-mail notification of sign off please provide e-mail address: !V ie,vi/)y o.J.w►6,✓1 e3 W etr i.Cell.(
Owner Name: Se -e /
Owner Address: Owner Tel. No.:
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.
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REVIEWED BY: DATE: i VA, _
PLEASE NOTE
COMMENTS/CONDITIONS:
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