HomeMy WebLinkAbout2023 Sign off Transmittal - Finsh basement home to remain 4 brms oV ` 4 TOWN OF YARMOUTH
S1.ir HEALTH DEPARTMENT
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•,'za=be*, PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: �,3 515 icy_ C lit / Y)//i-x2a , / g2,-// ,%,1 0,�-7S
Proposed Improvement: t9ft5"t,mt?•7 71- 22�-p/, 42yn� f,7/5L?q� #0 ,7�,. ii+e27�
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Applicant: (1/12 144'1 VA 5/l 1//9 Tel. No.: sOg ! 5 b 'g,5,25
Address: 3/ U C'/TP ,7 / f' it,‘,., fprl!/,a Date Filed: )_ ,2 2_ ,2J�3
**If you would like e-mail notification of sign off please provide e-mail address:
Owner Name: ( t k Ai ')/9 j/C t/l
Owner Address: 3/ ‘er7t9ia 2 r,Y/7éI7 ")/_ Owner Tel. No.: 5 off ' 5-1 g 5,25
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: d.8 0./N3
PLEASE NOTE
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