HomeMy WebLinkAbout2023 Sign off Transmittal - Demo 0v..YA"4, TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
21
Building Site Location: 1 0 c
Proposed Improvement: n e_rn o S 1, a.2 er eo - t Q J�L L
I/
Applicant: , ) / ^ / Q( p Tel. No.:b 17 ? 9 -26t --
Address: / q 1*) )/ Sq— 4 A ( Date Filed: ( Is , r2
-ice{ 2—0 2`-f
**/fyou would like e-mail notification of sign off please provide e-mail address:
Owner Name: l c7 et 6 17,U7 Ziet,7
Owner Address: / q 3 9vie)e,A.NQ / l Owner Tel. No.: 6 l -r e 2A
kit1/4(
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: DAT£:o
PLEASE NOTE
COMMENTS/CONDITIONS:
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