HomeMy WebLinkAbout2022 Sign off Transmittal - Use and Occ. New Owner / Painting and Awing over deck •YikL, TOWN OF YARMOUTH i,,A�( 1 t Z022
s r HEALTH DEPARTMENT
F LTH
54 �
H� DEPT.
-,=`` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: :\ b . \ (f�/l 03--f
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Proposed Improvement: \y\fi, and awn t I(1 o(Q,c 6.Q„o
S e cv c("J O G►n 11/4= Gc:.�sZ
Applicant: I�W\C\- ` Tel. No.:50 a,�O (Q 1�, D
Address: \ c\\\ cø& CA . \NC,,S4 0r(14 \I Date Filed: s
**If you would like e-mail notification of sign off,please provide e-mail address: 0,0ak\s-rf-0 e yApt l l Wi
Owner Name: \�( iz=\SW\/\ 373(1f)S \ Wire 6 ,'NOS(S-Y\
Owner Address: \ c.\\\'CYWC 8111 . \I �G u\A1/\Owner Tel. No.: (oU L,
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: SioZ,c--1 -a
PLEASE NOTE
COMMENTS/CONDITIONS:
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