HomeMy WebLinkAbout2023 Sign off Transmital - Use & Occ Carluccio's \�a TOWN OF YARMOUTH
a } HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: /D / Z S f� ,� .� L 7L-4
Proposed Improvement: " Cc_a
Applicant. /d "�Cy, .s Tel. No.:Je17— G --7
Address9 �- �� �� / /o �f F t f 7df Date Filed: / /f_ Z
**If you would like e-mail notification of sign off please provide e-mail address:G4r tk104,!".[/j g pr a
Owner Na d ' G /y 6/y_
Owner Address•�9 6'P„� e n v i //— �f Owner Tel. No.:f g-r2G 7f 6=37
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.
Ep Please submit three (3) copies of plans, to include:
(1.) Site Plan showing existing buildings, water line location,
MAY .1 b 2023 and septic system location;
HEALTH DEPT. 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: �� t , DATE:
PLEASE NOTE
COMMENTS/CONDITIONS:
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