HomeMy WebLinkAbout2023 Sign off Transmittal - Finish Basement to include Bed & Bath ° a TOWN OF YARMOUTH
off. , , 1 HEALTH DEPARTMENT
`��� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: if/ Jt,r-1,15 bct, 4,-, e 0„/--
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Proposed Improvement: ' D,S� N� 7 "6 �� ���
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Applicant: 1(%v,' 7ncI D giarreir) 7 Y c-/ f i Tel. No.: /V-153 —56 c7--
Address:J/ , a r .5/a , 49- C (tie 5 f >4r/ 9('$ ate Filed:
**If you would like e-mail notification of sign off please provide e-mail addr
Owner Name: Ut4 zim i r h QC-/ V i y/
Owner ddress:`/V 6DA 61,A A ve . Owner Tel. No.: 7f/(1,53 — 2
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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:
Nee twee (1.) Site Plan showing existing buildings,water line location,
and septic system location;
JUN R 2 2023 (2.) Floor plan labeling ALL rooms within building
HEALTM DEPT. (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: C11 ,�,s, j DATE: C - 07 7 49,3
PLEASE NOTE
COMMENTS/CONDITIONS: