HomeMy WebLinkAbout2022 Sign off Transmittal - 2nd fl garage addition os-Y`�k TOWN OF YARMOUTH
. � HEALTH DEPARTMENT JUL 1 4 2022
�.,, • ,:.T HEALTH DEPT
• '�•�`� PERMIT APPLICATION SIGN OFF TRANSMITTA -
To be completed by Applicant: ,
Building Site Location: g(QJStE( Roca LU�i1 t Yur& uk
Proposed Improvement: Cxtq_ kx W I \ts, ( 6 2*,t t 1( cC.Li it 1\
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Applicant: 3-aftick &f F1 (vanlfc f CaYt atA j ilii Tel. No.: /1"0)-01.1654
Address: N �t i(�t u' �� Yffi1w(t' Date Filed: j"/12.-t
**/fyou would like e-mail notification of sign off please provide e-mail address: 3i,�vr
Owner Name: Pft- FOrsthA "
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Owner Address: V 1,))112.,Vikr- �� (�Lk(I Owner Tel. No. OJ -WI - 63
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: 8 - 5
PLEASE NOTE
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