HomeMy WebLinkAbout2023 Sign off Transmittal - Garage Conversion o YA* TOWN OF YARMOUTH
1 a HEALTH DEPARTMENT
• '4'1`"``'� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant: 1
Building Site Location: �s• N d r �l ck ViC� c4 Y&r /14
Proposed Improvement: \e6 s &.S Cl,,v d C
Applicant: ICI\ 0 CL5 CTel.No.: OCR -96)
Address: -55 M6‘ .1CL, a Vv Q c A,- Yct4---1#1-tQi.A1-4, 4 Date Filed: /' & 'co Z
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**If you would like e-mail notification of sign off,please provide e-mail address: 11 CO v VV) @ crA ( �€C I, (4
Owner Name:
N1 C\ k Ce1.S `I
Owner Address: S !~O{AL W2Si;' KrImb N 'Owner Tel. No.: 6 4 z-set-1'3 7
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;
APR 21 2023 (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: 1,_"7-:::-. 1" DATE: 5 -f j -01_3
PLEASE NOTE
COMMENTS/CONDITIONS:
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