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Home My WebLink About2010 Mar 01 - Sign Off Transmittal, Floor Plans - Finish Room in Basement, Full Bath . . '.d . . . :_`�^'x',�"r,�,r�.�.m'^4T�T',"°';�°_^'.","-�e'"ziP^!'cws'°'__T'm,....., .� .. ..I � . . . . . . . . . � . � �. �: ��' ,�°� ��o T(}� �F YAR�t)�1'� � - y H��L"�'H D�PAR1'11�E1�t"T �' �,ri „ , �' � r* ��°"'°""'a �'� PERMTT APPLICA�i�i'�.SI+GN UFF TRAIYSMYT�`AL S�EET To be completed bY�PPlieant: Building Site Location: �Q �O N G F£L(.Ot,J ��2 t�� - y�,-,,,,.,,,��ap No.: �S� Lot No.:7,� �,►t Froposed Improvement: r�n� i sh r�om i�, ��rn cnT k n � �a�ro�wti ( �.e,,�\k�,�,t� . ; . -��— A.pPlicant: �l.�s �� l.:psrr� Tel. No.: Sc�8-3�S�y?�1� Address: �U � c�NG �.LL.c�r.J fJ+l�Je., C R rl�o'�--�-�, �� DateFiled: ' t I v **Ifyou would like e-mait raotificateon ofsign off,please provide s-mail address; OwnerName: S�x+M:e.. f Owner Address: Owner Tel. No.: � _._...._.................................��--�-�--.................................-�-----................----._...--�---_......---...-------.............._...-----�--......-�-�-�--�--��--��--�--�--�-----.........--�--...........--��-------........---------........----..........--��-�-----...:....---�-------....................:.....----........... RESIDENTIAL AND/OR CUMMERCIAL BUILDING . HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirernents For Septage Dis�osal and other Public Health Activities. Pl�se submit four (4) copies of p�ans, to include: (1.) Site Plan showing ezisting buildings, water line loc�tion, aad septic system location; (2.) Floor plan labeling ALL rooms within building (all ezisting and proposed)- N�e:F[oor plans not nequired for decks, sheds, windows, roo.finS'� (3.) If n�cessary, Title 5 application signed by licensed installer with fee. ; :;, ...- ------��-�-----�--�-��-------�---------------------�---........-�----...---------�-��-�-------....................-----..................-----:._.........................---�--.....---......................-�---�--..................------...---�---......---��--- REVIEWED BY: DATE: / �'j PLEASE NOTE �, . CONA�NTS/CONDTTIONS: im I' C4 mne e MWA for, man MOM v 0- MOST: 9 .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... lop. . . . . . . . . . . . . . . . . . . . . MOM......... Ve jMW Z7 �411 , its! V A. its w: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I' C4 mne e MWA for, man MOM v 0- MOST: 9 .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... lop. . . . . . . . . . . . . . . . . . . . . MOM......... Z7 �411 yw a if nT Af AM lot "'n• um"Ay 1: "A ti R, V'. cost STAW is Nov, „d.-..`9. �llibl� ................ ....... . ... . . . VIA: 5 Q` n. If V.- ........... "mom; US Y%w j, not MANA 7,� AS, Q y.,.p. Only A4,1 JQQ U1. 4M, . e . . .......... . WFr MUM Vote Ty ............. I' C4 mne e MWA for, man MOM v 0- MOST: 9 lop. . . . . . . . . . . . . . . . . . . . .