HomeMy WebLinkAbout2022 Sign off Transmittal - Finish Basement to include bathroom TOWN OF YARMOUTH
.�,�, HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
y Ro--Ab Agmw-rii
Building Site Location: -� 32). Viit- / MA 03
nr,osed-Improvement: F AOSIj 8•A EM ENr `C/ iJALL -THE /NTE") t_. LPubts
t?NS!ALL g�'L)'T �L' UNt► eLIM47F -c - .3
c) '& 4'7-ALL-- L --!�'Lt-43f+i I-PRee#1 ( Tol LE S[+✓.k, S( �Z�t+�ER.)
Applicant: / L'' S j"1> Tel. No.: (50 0 7-68 8(959'
Address: /5 PPIZTI4 1y lr�u�4 J i e — �••..
1 / Filed: -)‘'
**/f you would like e-mail notification of sign off,please provide e-mail address: '6-1,t 5 /i A ce r . k ' /0-S 1r0- X7).4
Owner Name: t1 Mii24
Owner Address: l D V' 6E-i L. S'; • Nc 1 v 1-1< . 1\1 A- "L0wn &°t) 7C5 - ?g3
� 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,
t" z and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
i-i E .3_ -n 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: ' a s5 — -�-
PLEASE NOTE
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