HomeMy WebLinkAbout2022 Sign off Transmittal - New 4 brm home bi-, --- Sy ,-
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o,.-Y'�k TOWN OF YARMOUTH
. HEALTH DEPARTMENT 411ki,
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location:
Proposed Improvement:
Applicant: Tel. No.: r /7 /i4 R{ G7:7(1
Address: ' - , .- r jt / Date Filed:
**Ifyou would like e-mail notification of sign off,please provide e-mail address:
Owner Name: r d j __ I L/
/v( (cZ 73Owner Address: 1 '--r + ZJ•L// L-? -� S _ � ' ' Oner Tel. No. 7-J t/ " `-� /
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:
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PLEASE NOTE
COMMENTS/CONDITIONS: