HomeMy WebLinkAbout2022 Sign off Transmittal - Convert WIC into a Bath RECEIVED
0Y.:/k TOWN OF YARMOUTH 2 ,t,
J ,�r HEALTH DEPARTMENT J yJ~~
;: HEALTH DEPT.
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:{�p`6� c�
Building Site Location: U P72-
Proposed Improvement: -NA.Lu4 \1 C . 1 Jj- -C- A -7 > 1 ii Pr t(
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Applicant: .....f.itt-tiOJ t.t.�2.t�c-�-� Tel. No.: 566.237K9)___
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Address: 70 Cli) ` 1../C,1/41e.-- 5 5.yaNNOW4Date Filed:
**/fyou would like e-mail notification of sign off please provide e-mail address:
Owner Name: rtiOw‘
Owner Address: -09'6- • 27- Owner Tel. No.: 5ce 3,4'4"
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 —
PLEASE NOTE
COMMENTS/CONDITIONS:
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