HomeMy WebLinkAbout2022 Sign off Transmittal - Use & Occ. Computer Store st-Y ,, TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant: ,//J
Building Site Location: /off' v2 &A/es 0/7-/A coi/i arrliOt/% /1
Proposed Improvement: O/ //JCS 0,0711/70T P/e Se/el/// i
Applicant: /?Te/CJC S• .h Tel. No.:6:4298 V35f�
Address:41 ,eh `JL ]74; S /�� Date Filed: th///94a?
**/f you would like e-mail notification of sign off please provide e-mail address:
Owner Name:
Owner Address: Owner Tel. No.:
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: ,4 DATE: .)""N
PLEASE NOTE
COMMENTS/CONDITIONS: