HomeMy WebLinkAbout2023 Sign off Transmittal - Handicap Ramp TOWN OF YARMOUTH
HEALTH DEPARTMENT Pl`.
'�• `` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET M
DEPT
To he completed by Applicant.
Building Site Location: I^1`> 5Ta}iccl\ owe So.`"Y"-`rtmou\A — t--tOt
Proposed Improvement: 40,,riet C� vv\e
Applicant: GV\c/A By-0 Tel. No.: 50g-(e 85-q1l(o
Address: ll� 5 .�� av\ c\Ak2 S o tl 1 Cask k Date Filed: 1'1 cl l o`er
**/fyou would like e-mail notification of sign off,please provide e-mail address:
Owner Name: R;C.v".c--U
Owner Address: rIS Sk—c-.+1 . aV€ Owner Tel. No.: 53E,(QZ5ctl(n
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;
(2.) Floor plan labeling ALL rooms within building
(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: ` AG/‘;
3•
PLEASE NOTE
COMMENTS/CONDITIONS:
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