HomeMy WebLinkAbout2023 Sign Off Transmittal - Demo of Home TOWN OF YARMOUTH
e HEALTH DEPARTMENT
\ ``'^°"e PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 1 3 C rou '+
Proposed Improvement: 1-}C'mo))+r an a e C`WetLI
Applicant: Qukr Ca cCt+tr - )C'v►.LL.►19 Tel. No.: 333 1) 1p 3
Address: �-I(( �c eri (�►'� , e yi n,S yyyn b 21,z 0 Date Filed: 5 J3 / 3
**Ifyou would like e-mail notification of sign off please provide e-mail address: vLP Je rCe U 'f4CPhn pan VS,CQy,�
Owner Name: ll; Q CTL I j CI`2 LL C_
Owner Address: / j `m Owner Tel. No.: (oo3 - Lc
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
G`�L�L�Z7LD (all existing and proposed)—
MAY Q 5 2023 Note:Floor plans not required for decks,sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
HEALTH D E PT. with fee.
REVIEWED BY: —<, �� � DATE: 5 - -
PLEASE NOTE
COMMENTS/CONDITIONS: