HomeMy WebLinkAbout2022 Sign off Transmittal - Finish Basement 0. Y•Lk TOWN OF YARMOUTH
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c HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant.
Building Site Location: QflY\ 1-A5\Ck.c-A Visa. NiCenMc.:)..:_,WNgin lo , Lk.V4 Cr
Proposed Improvement: 61'1\5'(\ \Dogs 'M4- , C&1C t i Z
f .V�5 Qc -. !'ted
Applicant: HtC.f \e Tel. No.: Sl•
Address: 14:AWNGcu;l\ %ktc\Aos i 2c y0.rIYk7• ncor , MA- Date Filed: -1 vaa ,
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**/fyou would like e-mail notification of sign off please provide e-mail address: tht\Vh\c1c1S Conn
Owner Name: 11/4.I0CM: ._ -3C.)‘.3C41-eit
Owner Address:i TCC a .C,ADYtc: Owner Tel. No.:-1St-l
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,
JUL 2 1 2022 and septic system location;
(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-- IC
PLEASE NOTE
COMMENTSICOND TIONS:
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