HomeMy WebLinkAbout2022 Sign off Tranmittal - Home expansion .Y1k TOWN OF YARMOUTH
.41 A ,r HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant: //
Building Site Location: 7 Pyle Ale_ L✓, ix-iv,e ,,Th
Proposed Improvement: � �1 �LGd �/`�/✓S 3e cf A � c&T hI
.z RCISr•A'‘ RC-OA6.✓e1 CI) C74C7a f1S t� 05
Applicant: t 1 $Ic e,, cf Tel. No.: J �' c(z-2-/ 34
Address: 6 Y #6-0/ 4,- 4),z.. 6u. ,eyalc,Vr Date Filed: f - L 4 - 2
**Ifyou would like e-mail notification of sign off please provide e-mail address:
Owner Name: ,a�4 eti,W/`
Owner Address: 6l Y i4✓1/-1v-e - Owner Tel. No.:
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;
OCT 2 m 2022 (2.) Floor plan labeling ALL rooms within building
HEALTH DEPT. (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: .,, ---ec-
?-6-VIDATE: f0/01 Y/-)-Z
PLEASE NOTE
COMMENTS/CONDITIONS:
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rled ry w. 577-,L x-pisce t 6` i6/i'9 -F.