HomeMy WebLinkAbout2022 Sign Off Transmittal - New Shed 0�=Y'1R.4_ TOWN OF YARMOUTH RECEIVED
p� _ LL c HEALTH DEPARTMENT
�,` OCT 24 2022
' ,C�E PERMIT APPLICATION SIGN OFF TRANSMITTAL ytt/TH DEPT.
To be completed by Applicant:
Building Site Location: a b .c ; V d a�� i l D . A✓j v„3..ktql G,,_. DZ.to-y
Proposed Improvement: /l)e yam' .� ,, /0 3 V 1
Applicant: 0 Z.f,i�-, vnt_, E_ II ' S Tel. No.:5)s '"g�a- �(i7S-2i4)
, /� v1ia-73
Address:9 L E -Pvo) 0Vao J 7 ft `U Date Filed: \ 7 24--72._
**If you would like a-mai notification of sign off,pleas provide e-mail address: Gt e e Ld S,(.3 6 trytin , C v/6
Owner Name: Stitlityvi t.
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Owner Address: 9-,c, .0 a,Al 636-- Owner Tel. No.: -"dC(cg -
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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: DATE: i° a'
PLEASE NOTE
COMMENTS/CONDITIONS:
IMP
3
LOT NO . : 7 ADDRESS :
OWNERS NAME : -ro A,....2,s2,,tacgs-
SEWAGEE PERMIT NO . : o 1 _ 2C3 NEW : / REPAIR :
DATE ISSUED : c -//.-o/ DATE INSTALLED : a_zo - o 2_
INSTALLERS NAME : aQt,9to l{issLi G
INSTALLATION OF : /3#xz-s"xzr
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WO ti2.0
WATER TABLE : /yy FINAL INSPECTION BY : 3 ,,,,RiLv
DRAWING OF INSTALLATION ON REVERSE SIDE :
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ITT
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� RECEIVED
a[ _ _ k0, OCT 2 2022
., '�' HEALTH DEPT.
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Ross/ RoAc