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HomeMy WebLinkAbout2022 Sign off Transmittal - Wall Demo TOWN OF YARMOUTH HEALTH DEPARTMENT o. t' = PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: y�,° '" f � Building Site Location: 140 t 1L�ij a Ml 1 ()�((,1 UAi'C,g i--j(Lrw.v IVl4 Oahe 4'3 Proposed Improvement: b ) I 1 v, .',. l t, k ‘41 < < .Ll_1 iJ9 tvn�+, Applicant aAA6L,Doltct r CUAC V1 S t _ Tel. No.:,SG8-691(1-'5 6/c7 AddressA't{ ererk — WP,S kirn Date Filed: (a L I s) **If you would like e-mail notification of sign off,please provide e-mail address: Owner Name: J 0,YyS Owner Address: W 0 ,N{ /l�XVtl h Wale- V'L 3d(?v ),teh Owner Tel. No.�/(4-8L /SS 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: (l.) 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. /r .. REVIEWED BY: it/ ( _ DATE: PLEASE NOTE COMMENTS/CONDITIONS: .4 ck) ° ‘413 f It 0 Nc !' s I _ ."011 %triai , �''© i a ' yr J - 3: do .. ..4 0) . _ _ ;.3". '''<e-- Ci --,4,, \r, , • J . __,..., 7...), . . . , . , . . • ... .. .. ......,. , ,, . . , • . . m, . .. . . , 1-- ...= - y c. r.7