HomeMy WebLinkAbout2017 May 19 - Sign Off Transmittal Sheet, Plan - Shed .., _
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�'�'`'^ `�`f� pERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
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To be completed by Applicant:
Building Site Location: 3}J �tf'vv� �-0�',
Proposed Improvement: ��\K \ � � -�C.,tQ-�,-� S�--�,/'�' N q,--�--�, �rp
Applicant: l' ,f � � �
el. No.: �-{ 3 U�2..�0 t�
Address: 2-S� C�/V��/1� �/N� � �-�(,�/(��pate Filed: S �
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**Ifyou would like e-mail notification ofsign off,please provide e-mail address:
Owner Name: �?T.N�'-�.l ►.�.t 6 W 1.��-.S ,
Owner Address: 3"� ��� j�, Owner Tel. No.: sp�—7 3? - 7 7��
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RESIDENTIAL AND/OR COMMERCIAL BUILDING
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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.
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.......... DATE: � /
' REVIEWED BY: ��j L����� 'l�'
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COMMENT /CONDITION : � ��
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