HomeMy WebLinkAbout2022 Sign Off Transmittal - Finish Basement 01-• TOWN OF YARMOUTH
;'-t- c' . HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: 3O (a QA O 4- RI) (-�-
Proposed Improvement: I I 0.00 O tq '(1OO(kA Pt -I\ 'W I14 RC)QM
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Applicant: Cj(\,v( t'• a\A• t Tel. No.15a) -3 3244
Address: ] (:)R-NtA t Lt./ 4RMOdk\-\ Date Filed: /101kili 2022
*"*If you would like e-mail notifications of sign off please^ provide e-mail address:
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Owner Name: ) JO [ONkkS Lv\•\1�
Owner Address: JO C.*.kNk Q) , Owner Tel. No.: (50 - 324E
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:
5t.051 (1.) Site Plan showing existing buildings, water line location,
\ O 3 2022 and septic system location;
;,c}I (2.) Floor plan labeling ALL rooms within building
HSA-TH pEPT (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: // 3
PLEASE NOTE
COMMENTS/CONDITIONS: �t-
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