HomeMy WebLinkAbout2022 Sign off Transmittal - Business - Use & Occupancy (Realestate Office) TOWN OF YARMOUTH
HEALTH DEPARTMENT
''�• `` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: 02
Proposed Imwvement: p v�,�� ` -P
Applicant: /47 47).'7D" Tel. No.: Gil" 7SS "/ 2//
Address: /9'7 ! a a Date Filed: &A`'2/-d
**If you would like e-mail notification of sign off please provide e-mail address: #04i L e 4 ,-17 " • ) "-cc
Owner Name: /1--.ti ` e /A. L
,
Owner Address:Ai Gi f� c(74'' e Owner Tel. No.: 5 /77 /
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:
RECEIVED (1.) Site Plan showing existing buildings, water line location,
JUN 23 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:
PLEASE NOTE
COMMENTS/CONDITIONS:
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