HomeMy WebLinkAbout2022 Sign off Transmittal - Add 3rd Bedroom *��t+'' k� TOWN OF YARMOUTH
IA
� HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant ry r,,/
Building Site Location: .67 jsrca f L po_evftidni
Proposed Improvement: k P D TIP 21 ED e--6G/(( Ey(S l`j FcOT(it'` I I�
Applicant: 66 Cg N`141i) 1 Tel. No.: �2 17 ?06 3
Address: LS KI TA- 14 *--B co koliLk /4 y O2. it( Date Filed:
**/fyou would like e-mail notification of sign off please provide e-mail address:
Owner Name: .5Ck rik9,
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: DATE: l —1 ),c)- '
PLEASE NOTE
COMMENTS/ NDITIONS: ���
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