HomeMy WebLinkAbout2023 Sign off Transmittal - Garage Apartment 7::' I"4 rd, TOWN OF YARMOUTH
Att-i" ,1-;
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant.
Building Site Location: C.c3 T00 9d L\'PS\- \ eck ON\ 0)u 13
Proposed Improvement: k-v,(-\;5v\ C.C,Cac,.( nv-[. Oed rOC-r'N, Ne trv; vX', VA
f X\-e r\ec -1-kink:1
Applicant: .(4-V k .e_ ,1 4, k-\\ Tel. No-:j6 fk 261 Z. -3 Le ? j
Address:L(3 T ( \ \�Lk \,,,,es -.( tv\C ,.. V\ w \ 6ZU73Date Filed: /, / ZZ
**/fyou would like e-mail notification of sign off please provide e-mail address: I c1'( (-1 S\von( ‘Zz �) cy'lco ` .Co
Owner Name: I`Yl-\ 1 Paf f";
Owner Address: (ifl-c 4 (, ` QS lIGv1 cam:,L--'1�� Owner Tel. No.:S6� NZ. .31Q 2,J GLUT 3
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:
I_y,..-. -=-•-- (1.) Site Plan showing existing buildings, water line location,
and septic system location;
DEC 1
2 2022 _ 2.) Floor plan labeling ALL rooms within building
HEALTH I DEFT. (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: Ri.,
711K------- DATE: id-- - 1 _IZ
PLEASE NOTE
COMMENTS/CONDITIONS:
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