HomeMy WebLinkAbout2022 Sign off Transmittal - Finish storage area upstairs (.<-:),-.:(4,-- \ TOWN OF YARMOUTH
liti, HEALTH DEPARTMENT
'�•`� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant: ,�� �� �
Building Site Location: p29 / s,?..e_hc..-4- —
Proposed Improvement: //vsalI-ir�' Div' ciu� ,eoc c SA/4 4
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Applicant: xA l�-�/-0' Tel. No.: ‘ 3) �S7
Address: �9% 4,4, /-e--? , Date Filed: /2 5— 7?
**/fyou would like e-mail notification
ic of sign off please// provide e-mail address:
Owner Name: � �/ �rl(1
Owner Address: r2'?/ CSC 7& Owner Tel. No.: 2)) 9j 7
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,
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- and septic system location;
DEC 0 1 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
fee.
REVIEWED BY: DATE: 1 €` 6/ZZ
PL ASE NOTE
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