HomeMy WebLinkAbout2023 Sign off Transmittal - Covert Garage to a Bedroom (#3) 0t_Y•I TOWN OF YARMOUTH
A
ae..�:.M �is HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: '5 W ,i ,' ) l Uk S <r)
Proposed Improvement: {—c/'/C2 i) 2 (LIA.. -A/
Applicant: (e)d1 V1 H t_t L_12I,4 V Tel. No.: 75)/` 7(f'9 '2S�TS
Address: 2/,- t(/ ( r j i t Iy
Date Filed:
**If you would like e-mail notification of sign off please provide e-mail address:
Owner Name: S ott i/ p } L(( f kki )Y
Owner Address:4 07 C %/ �)( i, Owner Tel. No.: r7 /
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,
and septic system location;
MAY 3 0 2023 (2.) Floor plan labeling ALL rooms within building
(all existing and proposed)-
HEALTH DEPT, Note:Floor plans not required for decks, sheds, windows, roofing;
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(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: , C.✓r--o Xk.� �_ DATE: X'- r -
PLEASE NOTE
COMMENTS/CONDITIONS:
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