HomeMy WebLinkAbout2022 Sign off Transmittal - Finish Basement .. :44r TOWN OF YARMOUTH
r HEALTH DEPARTMENT
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�•'� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: la 6•l`\Jeoc
Proposed Improvement 1 \-- c2 [-4tAA I ,�
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Applicant:L� �l"r Tel. No. 3�^ .&355•
Address Cfl Qf TOL AYYYD..) 1 t " lA Date Filed: 7 jec)/c9cQ
**/fyou would like e-mail notification of sign off please provide e-mail address. t C2_0.-- ckcc '-t`
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Owner Name:c —1 CC:r' 1
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Owner Address:79 3\\\Jc -Ic -Y Ly) 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;
Lit_ 0 8 2022 (2.) Floor plan labeling ALL rooms within building
HEALTH DEPT. (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: DATE: 7 -
PLEASE NOTE
COMMENTS/CONDITIONS:
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