HomeMy WebLinkAbout2022 Sign off Transmittal - Finish Rec Room in Basement TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF' TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: I O ►v(17-
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Proposed Improvement: r t A Is rt e. F\'L oO v-. , ,.1 j'4.4.5e vv T
Applicant: 54-6.-vc: C Iv '?" Tel. No.: SUY Z_`"17.1 (
Address: U �� �� t r,-� (n 1,),1 o z 4% ) Date Filed:
SD
**/f you would like e-mail notification of sign off please provide e-mail address:
Owner Name: 'a 2 f ay./ 0
Owner Address: I O`'t / 'QT (Al\Y r n y,- rn o-r'i Owner Tel. No.: t.f
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-"\-79 DATE:
PLEASE NOTE
COMMENTS/CONDITIONS:
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APR 2 6 ?022
HEALTH DEPT: