HomeMy WebLinkAbout2020 Sign Off Transmittal - DENIED Build a detached barn 'OL
roti Y� 'o TOWN OF YARMOUTH MAY 2 3 2022
HEALTH DEPARTMENT HEALTH DEPT
PT
=N` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant: q
Building Site Location: 3 [ \ 1'\i (7 ?DQ. 1 M A
Proposed Improvement: Q 0 Gl C` a¢.'kG. CX eoLer. dt-7 t.10 y
Applicant: Ja`-r i? Tel. No.: -7 74
Address: Pt BO x 3'144 Ya.ryucv , Pot-f- /2b4 G a-a7 7 s' Date Filed: 5'/a-( (6)-0?-0._
**If you would like e-mail notification of sign off,please provide e-mail address:
Owner Name: S\-Zvi ' 2ry( ICA r S
Owner Address: 3-7? (AWr-- . Owner Tel. No.: 50g - 39`(-5-06c)-
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. 2 )
REVIEWED BY: � DATE:
PLEASE NOTE
COMMENTS/CONDITIONS: