HomeMy WebLinkAbout2023 Sign off Transmittal - Finishing off existing space r.0N- Y4,k4, TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant.
Building Site Location: 3 2--- n/ 1-€'c 60
Proposed I rovement: •�t l S h S.' of b e 'I '6' S 6 /ote tv.(/��
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Applicant: 4j--7-r-y 4 // Tel. No.:CDg-2 cl4496Y
Address: 3 o79476 rS 124 Date Filed:/_f -2O
**If you would like e-mail notification of signlease provide e-mail address:
Owner Name: ��C� e/iL! ' /
Owner Address: ?2 72/ *,pc/ /2%" Owner Tel. No.:
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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: 20. DATE: / i ?/
PLEASE NOTE
COMMENTS/CONDITIONS:
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