HomeMy WebLinkAbout2022 Sign off Transmittal - Convert Garage into a storage space with greenery YA TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: 5 CUdyjival . SO (X:rm 0LfC ) 1 ' g olf
P •posed Impr•vemegt: ' L • i._[�0 . r► XPi.,. & .'f,P IA —! Vet 4' MY)
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Applicant:PT' \\Oi 1J\ , Al\AQ.-VSW Tel. No.:
Address: (`Qt 'a &' S d A Q 1rik /t r l 164Date Fi led: l
**/fyou would like e-mail notification of sign off please provide e-mail address: I i/
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Owner Name: Pr(��1\� � • er
Owner Address: 3 < Cie( S4tztAS0 9annottkOwner Tel. No.:_
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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: Oftbi
DATE: 8-- ^ 01-- )-1--
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COMMENTS/CONDITIONS:
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RECEIVED
HEALTH DEPT.