HomeMy WebLinkAboutRevised 2022 Sign off Transmittal - Home expansion and Garage ;Y Ak,, TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant. i LO
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Building Site Location: 422c L' c- v c, / NCA/ IG,
Proposed Improvement: 7Ze ve 7 // 4Y) c c! A -3,,
Applicant: , C r Ct -a 7c1 Tel. No.:
Address: ,2 ( Date Filed: /( L 2 - �Z
**/f you would like e-mail notification of sign off please provide e-mail address:
Owner Name: A.Gln �I1 t'N er „c .
Owner Address:i9t c 6 cA..er,-,, K $ 44 I 1 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;
NOV (2.) Floor plan labeling ALL rooms within building
22 2022 (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: DATE: ` — 1)-4'
PLEASE NOTE
COMMENT, CONDITIONS:
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''‘...:4-:cir TOWN OF YARMOUTH
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HEALTH DEPARTMENT
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PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: a S cc„..pi- . svt,‘„, t (
i .,) 5„,...,..b000k
Proposed Improvement: 60.Avv-v--7 "1-3,.,r-k- -R. ci £.L -.. .jA.- , _I-7!5/9,4,1,1 X. ICI ote t,
73 e. (0 a..v. Ar\y,,1 (-2, "g
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Applicant: 6 a 512( (- Cd Tel. No.. E ci
Address: 1 4/ #-e-vi 1- re-
4 P4 - Date Filed:
"If you would like e-mail notification of sign off please provide e-mail address: ___
Owner Name: g c-c,1,.4 kJ
..._, .1 17-e-e-ci ,
/
Owner Address: 0), 3 e,---ro 7. S.,"Ali Owner 'el. No.:
/
RESIDENTIAL AND/OR COMMERCIAL : ILDING
HEALTH DEPARTMENT: Determines Compliance to State anlown Regulations; i.e., Requirements
For Septage Disposal and other P.ric Health Activities.
°)- C
c. Please submit three ( opies of plans, to include:
(1.) Site Plan sho g existing buildings, water line location,
and septic . tem location;
414 k(1. (2.) Floor p , , abeling ALL rooms within building
t k (all e mg and proposed) -
j ---,,,...i-)-
rat, i.,, - No•• loor plans not required for decks, sheds, windows, roofing;
(3.) ecessary, Title 5 application signed by licensed installer
ith fee.
Ord" -;PA
REVIEWED BY: de
/ DATE: i° (( ---1 --i PLEASE NOTE
. 3COMMENTS/CO • 'IONS: it2) gc. vti _et t 1,1 2
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