HomeMy WebLinkAbout2023 Sign off Transmittal - New bedroom #3 'YA4 TOWN OF YARMOUTH
s'' 4 c HEALTH DEPARTMENT
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",,,,,„' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant: II � ,,
Building Site Location: Z9 C@Clch hnah s Lahe, wesf Y�-knousf h _1'ifj / O2 13
Proposed Improvement: e Lv 1 e CI,h ro 0 or a _) LA--
Applicant: C ¶al-cA 2.h CS Tel. No.:
Address: C Sac V\ Qh S l C O C, W' . \lat,1•Y1cu. 1 Mil Date Filed: I I�4 / c 3
**If you would like e-mail notification of sign off please provide e-mail address:
Owner Name: C t aN a Pi r e S
Owner Address: °2{ e&cAcr 1h•1q h S LQh e Owner Tel. No.: (7 0 36R 02165
West- Yamrys,u.— -in A) 02G73
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
(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 DATE: . :/(1 'ol-
PLEASE NOTE
COMMENTS/CONDITIONS-
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