HomeMy WebLinkAbout2023 Sign off Transmittal -Interior Remodel TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant.
Building Site Location: S.:" 1k.)- YO/11/40i/t-ci1l
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Applicant: (.;$10-ei Y%. CtO'r (I) Tel. No.q-6-pc-spc
Address: gffct-i Wej4iviA f_ck thAutAck. Date Filed -3 3.
**If you would like e-mail notification of sign off please provide e-mail address:
Owner Name: C4:C._ ilt(" Gra---11ALLC
Owner Address:LIOD 11610 S\-- . ,b2,1Arrti Owner Tel. No.:19S- gill" cat/
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,
Gag-6[ZOVED
and septic system location;
FEB 0 3 ZOZ3 (2.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
HEALTH DEPT. 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: — 7-
PLEASE NOTE
COMMENTS/CONDITIONS: