HomeMy WebLinkAbout2022 Sign off Transmittal - 0eck extension o+ Yak TOWN OF YARMOUTH A 1G 17 2022
HEAL
�• HEALTH DEPARTMENT T
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: ,eieJC,v4IfD S' f So, r),- cri-A
Proposed Improvement: i9•Ufi? g' k
z ` E'x'�"C.clS J,ti 7-0 xJsl/J1 ,Dpeg'
Need 3/1/'Foo_/N6S MDQ -re,1 QA) D"N\C.k-1
Applicant: )4/Li A.461 sbipeAcR Tel. No.:4O/g37�0
Address: JO6 :5:pdet 10.—P L. 4Are 126 ,i(i4 0'2763 Date Filed: 8t 7/2
**If you would like e-mail notification of sign off please provide e-mail address:
Owner Name: 1. -e-rA p��vC
Owner Address: 7 ee•golva 57 50. yet Et'n'a U 7 Owner Tel. No-5--1W 4 WI
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: e — Ds--00....c
PLEASE NOTE
COMMENTS/CONDITIONS:
;1 � o Li NI
0
V .-1
-t, IN v\ `-') j s -z., ----. p____
a
1 , _cb-%<k. _
N _
1 1
. ,_
. ;,. lif N- c. ) ai,
51 /4 —ii - •v. u. . ., ,
—AN
: .... s. _ 1 (4_
N � � jE` er. 4
11 I.:
i r
l— —
,
( k'' „,(7) ----9 fb, i. Th-
qt 400 i
• _M i,- K\ PL. -t
d
y
r-
-1-eareiz. , ?\
sit-re
•
_z O 4 ? , -r-L--- ' . ----
ts
'29
li
i
Q
TNi tp o o
�; tom` o �` ,�6
E, ca r0 �, ,� �C T,
)1\
W
otti k k,_
rk-
IN 'w U
1 [J N
W
��