HomeMy WebLinkAbout2022 Sign off transmittal - Finish Basement ,,,.,-'',,k� TOWN OF YARMOUTH
� r HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location:3r Ade,j12/s ,� . g k xy.,,,„,..,,* , f, 21,.,6713
Proposed Improvement: A/ eir r77, 6 iex / &,. .,., �,,,,,W4
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Applicant: fri 7 4-4 Tel. No.: •ag 2go-4-nS3
Address:3? % c _ h/es,,,..2a�,/' ',li 73 Date Filed:
**/fyou would like e-mail notification of sign off please provide e-mail address:ir# (J3 V07,041//62‘p.7
er
Owner Name: 1 /s
21-
Owner Address:tj# �V��� �� u/{S .�, Owner Tel. No. d�Z .�
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,
RECEIVED and septic system location;
NOV 16 20Z2 42„)) Floor plan labeling ALL rooms within building
(all existing and proposed) -
HEAL iH DEPT. Note: Floor plans not required for decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
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REVIEWED BY: J DATE: (/ /8— -.
PLEASE NOTE
COMMENTS/CONDITIONS:
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