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HomeMy WebLinkAbout2023 Sign off Transmittal - Basement bath �:�,e-,'� TOWN OF YARMOUTH j c HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicant. Building Site Location: J To C 5 r Proposed Improvement: tf l) I) (e, (! o'v- r l e c, to, ck Applicant: e _• ( ( 5. c frig' Tel. No.: (N) Zc ( 07s Address: 3( S /6')44-v C L 1 lT` 74-e,-/ 0.4/ /6 101 0 t v3o Date Filed: Os— "If you would like e-mail notification of sign off, please provide e-mail address: ref"fi 7 SAC�e t `/`/'r' 111,i/.(se' Owner Name: C' '9( (/ $ ( ( /t `io Owner Address: 3/ 3 Y t/L eci c`A Owner Tel. No.(C'7)))0 5,75-7 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: (1.) Site Plan showing existing buildings, water line location, R WED and septic system location; DEC 08 2022 (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — HEALTH DEPT. 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 a — f S PLEASE NOTE COMMENTS/CONDITIONS: o c n _ m © m ' t'11 N O N 1-cP 1 agadmakrasgarapsonnoss S17 o S C9+ 0 7 cs v D z � 0 C r m 0 rn ‘1 r; ,,-1- ,o , rt � - s C (- c4 1 w �1 v i W C • � f i „ - �; c S y c �c- c - C 7`� ` ` al :--L) 1 \.A ...re, U 1 Cs- a .\_. - .4.......4 , - t t , i • S 9 i —mil 1 n n ti - o r l"IN ,\ C