HomeMy WebLinkAbout2022 Sign off Transmittal - Use and Occ - New Owner Qla:CaD
ov:Yrtk TOWN OF YARMOUTH
77 r', HEALTH DEPARTMENT MAY 12022
HEALTH DEPT
PERMIT APPLICATION SIGN OFF TRANSMITTAL
To he completed by Applicant: /� �'` �� /� fBuilding Site Location: /s2. OLD "GAJ ` 56- /c2, $//iuina4 '� ` $
Proposed Improvement: `;47, j1-U f' }-1i-,f- 6 ' I-5
VII/ i j 4 /f~ Gr'fi
Applicant: /ind6 a Tel. No.: ( S`l9 7`MT-
Address:
am`/ --Address: /f2 �/91/ ii wI*41 „tr! Date Filed:
"If you would likes •:cation of sign off please provide e-mail address: / 11 MO,iIr 1 D`f C (') ,-()',i4'',',
Mf .........^Owner Name: /517/140/4-14r
Owner Address: / I'197a 1! //I" / `�l'''' Owner Tel. No.: 5Or7-'�/' �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. .,,i< / ,,, DATE: 5/37/
PLEASE NOTE
COMMENTS/CONDITIONS:
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