HomeMy WebLinkAbout2022 Sign off Transmittal - Rebuild Interior .Y�kr TOWN OF YARMOUTH
HEALTH DEPARTMENT
•
'�• `� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant: \,
Building Site Location: —7 Li oA.--cr Sk-r_e_121- ; U zS1
Proposed Improvement:
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Applicant: Gj�c,, �=n,r� �'� Tel. No.: 501-'3'7 b - n4-5--
Address: 1 Li 6 5k C f \"/CA(rna. yoe--MA 09\0 s' Date Filed:
**If you would like e-mailai notification of sign off please provide e-mail address: G.n Sla»FIo�J-ey zin�. m
Owner Name: /l t,.3 O (-e_42, `4 LLC
Owner Address: N c,rma-M. pc:cA' Owner Tel. No.: SOe'-`I i 6- acC-6
.......................................................................... ....
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,
RECE+V D and septic system location;
NOV 0 8 2022 (2.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
HEAL TH DEPT Note: Floor plans not required for decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: r //
DATE:
PLEASE NOTE
COMMENTS/CONDITIONS:
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