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Home My WebLink About2022 Unit 3 - Sign off Transmittal - Demo Replace back steps 0t-: ,f TOWN OF YARMOUTH A .° HEALTH DEPARTMENT S' iy `•itT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: 1 " 0 A. . r' Proposed Improvement: q ,p� ( , ;:_,T-•_ i _k u<'`i As Ji t,� r---.„off ,..., S 1.2), (.i Applicant: d it/ t/ --t 1 &- fr Tel. No.: b,,/ /12.(,_ oh, Address: v 1,:dr- •o i i2.,1 14L I I p 0 %,4 S Date Filed: **If you would like e-mail notification of sign off please provide e-mail address: Owner Name: ra a,r n, �' Owner Address: (/J9/,,, e Owner Tel. No.: , ,,a_./...,.‹.)a 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,1 cuing (1.) Site Plan showing existing buildings, water line location, and septic system location; JUL 2 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• - (J / DATE: - -, PLEASE NOTE COMMENTS/CONDITIONS: • .• . ,- - ' • . - ,, -, ,,..r1t7.7,:--.17•;•I'•'•"••••''-•- ' \A/Ay 1 * -* * irr- * - NMI 42 7 :77 1-.• * ...* * 5k. Ai-- .... •,..-• p:A.. _ • ornr-E: : .,.. .....,.,, . ,...- •• ,7,4•144-: • I' .--- 1;;:71-ItYcili.: L.._. ... : ••'`.......).7-1 i Gi fri c.:_-: --;•-•:= l • _._.__.. ... . ...•••, . -L / ;"-t (-'•F,',--1:::-•.•:,i'si I.- t-:n-,- " ' ••-• .4-• r--1-4-.4.••••N--...:..--,„,- •- 4 . .,........„...,.., ,...i..., 1.7,,,.: ,..,.._ a,.. 1......_:•.1.. ; • _.., e,...=.77.7,..;:.,,,i-T.,--..-.7„ :____:__ ,______ . .. : \ .. .. . .... .... . ,... ._, .. .. \- IEEP-1111.111 ,ea.„Ir-WiNglialig-wei v°111`1111!) ‘1°"A. . %Z g. • I -, ,.. C... . • - m_ mom (o', illic _ . 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