HomeMy WebLinkAbout2022 Sign off Transmittal - Rebuild 2 Units with Bathrooms TOWN OF YARMOUTH
**it4HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: 4 57jj LL1\.,a
Proposed Improvement: (' ir\W"VC-3
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Applicant: bC>YUL N.L/1-111t Tel. No.: 5O@ 22 g-36 I
Address: 7,t pory.T- Date Filed: 5(z7
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"If you would like e-mail notification of sign off please provide e-mail address:
Owner Name:
Owner Address: Owner Tel. No.:-7-744 836 - 5—CO S
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 ASE NOTE
COMMENTS/CONDITIONS:
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