HomeMy WebLinkAbout2022 Sign off Transmittal - Finish Basement r.ot.Yi ;�, TOWN OF YARMOUTH RECEIVED
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, HEALTH DEPARTMENT JL U 1 'r ',�r
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''_�•`� PERMIT APPLICATION SIGN OFF TRANSMITTAL SAW-TN DEPT
To he completed by Applicant:
Building Site Location eLS7 4 41� AC ,11-eg,( A
Proposed Improvement: /5:124.5 15elitelZ
Applicant: 4774/ cS7/0(_________ Tel. No.:90TH `O? 3
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Address Ii4L4 - I A y — : ,�4 ,� �% Date Filed: j
**If you would like e-mail notification ofsi: 7 off please provide e-mail address: 7, /-111f .5poi
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Owner Name: �i /► A! ia�� ' ' A"
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Owner Address: Owner Tel. No.: PQ 9.--929X-3 7
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.
REVIEWED BY: / DATE: -7 _ I C - 1-2-
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PLEASE NOTE
COMMENTS/CONDITIONS:
4,10.064'
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