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HomeMy WebLinkAbout2023 Sign off Transmittal - finish basement o.cYA r TOWN OF YARMOUTH ,.n 4-4, oe HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: l� Building Site Location: l CO P . S '�D cJ ck/ (tic t' c' (,4 `q/` Proposed Improvement: t54sc (,Q i`—.4 (L.;- f�m 7- i 47-l- iUc u.3 LJ4t-41.1124, j N V-1Ikt -6-F' 7 A1Z Pt_, .t=J1/4P i! )-c7 rz-A.I?AC... . 1-11-r47-/.0<s- , LJ r/ t'c' ,dL— Lj 4,- '_? Applicant: r/c ,v A _ A Tc—/ Tel. No.: 6:117 S- (7" ,4 Address: /uLpv 4A k,(S _ j.-- „o ,2A/ t,-{64 Date Filed: !*-13/�-.S **If you would like e-mail notification of sign off,please provide e-mail address: Owner Name: 5'.f ip c&e.4. Si. cUAL 33?-Seek-7►'e Q Owner Address:a 3 a Ce D. I t u ., • Q u?Owner Tel. No.: 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: RECEIVED (1.) Site Plan showing existing buildings, water line location, MAY 0 3 2o23 and septic system location; ..'- 2.) Floor plan labeling ALL rooms within building HEALTH 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: �/wc.^o 61� ` DATE: /J " /k- 3 PLEASE NOTE COMMENTS/CONDITIONS: Subject; cv, I\S-\.© f- W CU./ t.e,„ t,Aram1 1 f �` Data/3 10,3 (.0 Y,e .r PAGE: t v if C( 1 iv\ 1 i3kx3tc ti Ltuvvuet SPaGt , lr --/,\ \\`► RECEIVED '.,c' , 01,-,...--r \,_. , �s41.� f�3 CCI3jC MAY 0 3 2023 s "ter 3 �.� 7' �9 c t j 1 HEALTH DEPT. (,� s .11'' �' - , A 1 ! D y.? . sim u _9 0 ( & e q•-• 1 I/ t a A(i 0,,) q,b, , x x i F: 0 1:-. . <-.,te,./ , ( \ H . ( \ <, .., , 9 44. : --.) i T ` ' cr.- I,,c.,r4,, ,, .fx),b, ' M • esy Subject: q (Q s \ 0 rr W cu./ l Ca r J cA Date _/3 p,3 w: M. a / PAGE: i CC a'3K k3f / // ► Q.00St6Ft - , ! i c .1 �� (Ca' -?-.., ``' ': RECEIVE© 0-- ..."--: , '--- 1/ GC3 CCIiiiC '.-- — .J y' ; . c MAY 0 3 2023 445 .�. in ,.3 1 1,C . \€ r' HEALTH DEPT. l" , v/_,, ,- -r .9zK /0/ _...� Mamoru r S '�t" 4 _ ' � m ti, v _9 .3 .G. j 1, , CY R rA ! rtc,\ t ,� A(h(©`;t 2`D V . - .0 x, c., r- t< t, 01) /! \ 0 E I; A, -,I <-).i"'ea7-/ I , .. ( \ ---) i \ �. M‘.S e - be J i0z.,(-'-1,,f ),t,iJhhe