HomeMy WebLinkAbout2023 Sign off Trasmittal - Garage conversion into Family Rm A
..��.,'� TOWN OF YARMOUTH
a. r HEALTH DEPARTMENT
'�• '� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant: e�
Building Site Location: !A 1.,� yl 1- . ycy-froll-pc. (-J-
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...Improvement:L it40 • -r✓ls cti p
2Il6 ' sec IL-0-0
Applicant: //k7 ,eyi �yy _ /Iaive4V7 Tel. No.: 46' ( 1c
Address: Q ),Y-/vL_.. 1- i `� Date Filed: VZ6/Z3
**lfyou would like e-mail notification of sign off please provide e-mail address: kUL 4/Q4WW)G U'C�7 /1t f f•
Owner Name: Sit I—!it'll')
Owner Address: IA 064 u ` 5-74( Owner Tel. No.: r Zs./_ g-ic 1 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:
c4 (1.) Site Plan showing existing buildings, water line location,
ti �� , and septic system location;
p (2.) Floorplan labelingALL rooms within building
y )F,0T ?`� (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: L ?-77 A 3
PLEASE NOTE
COMMENTS/CONDITIONS:
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