HomeMy WebLinkAbout2016 Jun 16 - Sign Off Transmittal Sheet, Floor Plan - Repair Water Damaged Walls, Ceiling _: _
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��''��.=�%��� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant.•
Building Site Location: '7 �u�✓C �S � �el. f,,�k `c ,�F
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Applicant: � �;�� J�'�j S `��/g��
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Address: Date Filed:
**Ifyou would like e-mail not�cation ofsign off,please pr ide e-mail address:
Owner Name: �'�� /,1,��
Owner Address: Owner Tel.No.:
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RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septa:ge Disposal and other Public Health Activities.
Please submit three (3) copies of plans, to include:
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(l.) 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.
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REVIEWED BY: DATE: � l� "O'
PLEASE NOTE
COMMENTS/CONDITIONS:
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; JUN '� � xo 16
HEALTH DEPT.
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