HomeMy WebLinkAbout2022 Sign off Transmittal - Finish Bssement oN Yak TOWN OF YARMOUTH
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HEALTH DEPARTMENT
'!,.•„,` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant.
Building Site Location: 9 f n ft5-1 i R R6 VJ• em(OkA (ni l`� 26 73
P posed Improvement: i v\S_ 1 A pc eb CicHt_1. , ein_e_4____g,5 co,�__4Vs p en Rt�r1f - b2og
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Applicant: QeYlAl-D QE I k A Tel. No.: 5(43 _36 D 9 oC,f
Address: 'q P n 1-O$ .A M , . poz ryvDlJ Th plis Date Filed: 9 I 2 81 aka
**/f you would like e-mail notification of sign off,please provide e-mail address: SU c. .)E' 1160€ 1 *Yr Q 1!4 Co m
Owner Name: WQ N iN-N O ( (Z E t Z A
Owner Address: 5A nn e (\ C Owner Tel. No.: 508•,A400b8
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,
RE : ' ='' and septic system location;
(2.) Floor plan labeling ALL rooms within building
8 (all existing and proposed) —
Note: Floor plans not required for decks, sheds, windows, roofing;
HEALTH DEPT. (3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: DATE: / G _a S e 1 2,'
PLEASE NOTE
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