HomeMy WebLinkAbout2022 Sign off Transmittal - New Business ( aka 527 B) TOWN OF YARMOUTH
r. HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant: //
Building Site Location: J 7!7 M f S TREE l
Proposed Improvement: lv,k) 13u S_TN L 0tv k?
a Sirs
Applicant: i ON 6 'OAJ -KID10 0 Tel. No.: 774"*/-0 f7P
D r/
Address: 0 4,n X' 13 R3 �9 �PNtv�� /44. OaZ6&O Date Filed: s/�bd al
**If you would like e-mail notification of sign off,please provide e-mail address: .Z-0/1/6 e `1 oN+=y dad d Ca,e,CpJ, ewt._
Owner Name: Vi e_ aS U1 -
1oJe I
Owner Address: Owner Tel. No.:
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: d' / 2.
�+�..� DATE: �/2`p/j
PLEASE NOTE
COMMENTS/CONDITIONS:
076 M&s\j St,
Honey Dew Donuts 10 Seats Total
-..................- Ara.,,2, LI '-
, "1.10 1 -ral"
'''4 i
1 _ JCS
—— —�- x Lr
L. 2022
y a 1 _MAy 6
-it HE-rE 'v tiouL i _ i -�
LE �-H DEPT.
1 1 , f �"..'�.....4 t.► HEA
I
L_ E —411:171 —i ( Mf L i I t
11 (� 'I' ! -1 L__...__ L _ _ J
L OFF-IC- 1 !
1 1 P FR 2ER C001 F L;
L
i .-�__
,..._ r_..4. ._. ......14 .r
1r I `� i .
I 1
,.R1_, Et i . ,1HTY
` f
EN _ 3
ak___ . l _ ,
` = ! y
t ltt t til t 1
C".._ ti
.T-n
:r..7141
i rr — -- -
++ If'
p
r
.r 1
1
At 1 FM AN[Ilirf
I
•
•
6, FM ,
r - __.... _�t - H L
1
1
I t ; tt --