HomeMy WebLinkAbout2023 Sign off Transmittal - Bedroom Addition / Septic upgrade 0_YAK TOWN OF YARMOUTH
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-44, t HEALTH DEPARTMENT
.', PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 145 C-c OCt c 5lc--
Proposed Improvement: 2:)--cc)(00 Yv\, ct,8c.) IA-to V\ / g z- 121c�C -e Sr p t C
Applicant: rs v 1 d 1 \ Ct u V\ V\ci Tel. No.: 6 0 3-9 S S -q LL 4,6.
Address: i to r-ta i- .o,A d r. V,n \ s . Cr,c u t C7 330 Date Filed:
**If you would like e-mail notification of sign off,please provide e-mail address:
Owner Name: Klrva-r. tko l ‘-e r'kc.\p " -2 7
Owner Address: LB C Y do ( _S\ . \/c t v'n otAL Owner Tcl. No.: G(tj-'MS -38A5
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: Cc,.—..• 0 L._- DATE: .2 - 02 ry -a
PLEASE NOTE
COMMENTS/CONDITIONS:
DATE: (j
DONALD I. MEYER REVISED IC , _
Professional Building Designer
P.O. Box 532
So. Yarmouth, MA 02664 DRAWING NUMBER
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(508)394-5296 ,
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OCT 2 8 2021
HEALTH DEPT.
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