HomeMy WebLinkAbout2022 Sign Off Transmittal - 2nd Floor Addition TOWN OF YARMOUTH::*.n A HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 3 A✓l&,�w
Proposed Improvement: 1� 4- 0 ucz.V t£ic_t_ (1/U6 jvV( I 13ems( v' 1 vh- .I Y
Applicant: G t� / Tel. No.: s° 0S' ?,e)3c Z
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Address: 6 ( p�-,ikye, .7 Z �� Y /'KGB �/4-. 2Date Filed: -Z?.
**If you would like e-mail
ill notification of sign off please provide e-mail address:
Owner Name: /14 V I VI Cr ereliCh V*
Owner Address: 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 .122
(2.) Floor plan labeling ALL rooms within building
(all existing and proposed) -
HE9!`," 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: l 0 r Y - Z�-
PLEASE NOTE
CO MENTS/CONDITIQNS:
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