HomeMy WebLinkAbout2022 Sign off Transmittal - Use & Occ I
ON..Y4k TOWN OF YARMOUTH
�r HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applic�annt: 6&UI\
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Proposed Improvement: /it/4 l j e. 0/fk‘, ��/(///®YL$ .va,i° l 0�, /
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Applicant: /Za a /`Weft/'/ L/_P �errcr t' eiYa Tel. No.: fr?4) 4- YQ*o
Address: g # old!? Ida // 1/ ail?/t/S� t// -- Qo2 aJ Date Filed: .:���.��7��0�,2
**If you would like e-mail notification o sign off, please provide e-mail address: 7zi/a C C�w' a a� 1, a/4fti- Ce/11f
Owner Name: fkit4 a yl C n(2(-/
Owner Address( Owner Tel. No.: (sag VI ^6. 45
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 2022 (2.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
HEALTH DEPT. Note: Floor plans not required for decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
wi h fee.
REVIEWED BY: K DATE: II l -/i Z.
P EASE NOTE
COMMENTS/CONDITIONS: