HomeMy WebLinkAbout2022 Sign off Transmittal - 3 Season Porch `N-•Yak TOWN OF YARMOUTH
r, HEALTH DEPARTMENT
''�• ` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: sP/iv/i/X7 /P` ij7 t'( A 4,,,,ovriki
Proposedm ovem t: i i ( o >< (Z _T l"/4€< Sleh-s-o&is G�
6/.1 Ta, C r - AJ. Cn
Applicant: V•//4 � Cl C(LG /2 '4 Tel. No.(3--6 ) 3 4 ci i o
Address: </g_? uQ/►'I't �?' 9!'� 1 �,W Date Filed: 7).7
**If you would like e-mail notification of sign off please provide e-mail a dress:
Owner Name: 96 N A/ 6 /6S-ti/
Owner Address: ? i/ " ' C, 4J , setytH livirwit, Owner Tel. No.: (2-4°3)sq .333e
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;
JUL 2022 (2.) Floor plan labeling ALL rooms within building
(all existing and proposed) -
HEALTH DEPT. 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: 7
PLEASE NOTE
COMMENTS/CONDITIONS:
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