HomeMy WebLinkAbout2022 Sign off Transmittal - Turn Loft Area into Den & Office ,DN-.I'tk TOWN OF YARMOUTH
:>•-74t. . . HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET-----__—_
SEF 0 e 2022-'
To he completed by Applicant: p f) 2 i n22
HEALTH r��T -
Building Site Location: `►'"'G�t .S I
Proposed Improvement: •7,t,t/ 4r/ p1ii.e4 i c7PF1 Ce 2 e
17 CNr\ e 0 /tic re, Lycv v-e C cz.St, c p-e (--v---,p-e✓ n CIA vLi'
Applicant: 7 .i/ ,y%.uv Tel. No.:.c3F-0)$Y'G Vel-/
Address: 2' GcJii,,,-C4,44. C7' Date Filed: ?444):-,&
**/fyou would like e-mail notification of sign off please provide e-mail address: alel-- 94c-Pee,v144c t�y (1 �/,y4. -C0/7
Owner Name: Wi-/ ,e` n'etc-c) / /
Owner Address: Y pit/i f-tg tFt� �,. Owner Tel. No.: cb c)y y_6,o?2y
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.
1111
REVIEWED BY: (1 DATE: 7-76----a
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PL 'ASE NOTE
COMMENTS/CONDITIONS:
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