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HomeMy WebLinkAboutImage_015tif-^B5,\EZ 99 8ut'k lsland Road !v(st lhrmouth. M,^ 02571 Telt ptll e: {508) :7r-7921 ' fJx: (5061 771-79)B BIIILDI:iC PER,IITIT .{PPLICATION FOR \I'ATER DEPARTTT'tEI\T SICN OF-F TRAISII TTTAL FOR}I BUILDING SITE LOCATION: -t3 0 D PROPOSEDwoRK: C0Nlen{€ APPLICANT:IC ADDRESS:I C tl,Axol DIlru c tfm 6no TELPHoNE:q8l $qtt qq6 cclt 9l RESIDENTIAL AND 1OR C.ON,IIt,I ER(.IAt. BI.-ILDING Watcr Dcg(Iltn€nt; Enginecring Dtpanmatt: (lonsEft !lion Commission: Hcalth Dqrartment: [:irc th 44 -Q9st1-r /)60 5_O{t 5 Dac'rnrincs Conrptiatrc€ of water A\rrllebitily and or c*iding location Dctcminer ('ompliancc for Psrking end Dr.isagB Daernrincri Complistrcc to WcnlarKli Act; i.e. ll krt(s) bords any t1trc of wetlands, streams. ponds, rircrs, occan, hogs, hoys' marshland, ETC" ' Dctennirrs ('rxnplianc:e to Slate atd Town Regulatiots' i c. requirements for Scpragc Dkgrsal and ohcr Public tlcalth Actililc Drrennincs Compli&JB to Statc 8rd Tovn Rcquircrrsrte fot Pcfonal cctions, i.e. Srnoke Dclectors, Spritrkld Sysf6ns,elc \TE,\PPI,IC R OFFTCE llst:: COIIIMINTS ON Pf RilllT APPROVAt- OR Dt-lil.\t. tall\ 11.WATER DIvIStO}I (SIGN,\TURE) ,za2 tr\Tt 3 ?to r^na a13G3'r ,z I \ N.Crlord, Ie Ot OgzPEON& (506) 9S"_0026Pl& (5OE) SS4-Zg3 LAT'UUiTLUX U)CAIION lJ GAY ROAD SOUTH YARYOUTH, I.A REGEIEY ,.l!DE tnq &E'f,xEl{r ,r aFal4r( rcoo}t \ E6. rat,&EutE loqEEC cEY EClIn,ratE xf rr !@ lErDrD llg/Da M. @a 97/57 FffiEEgpnrrrr.!E ,lrI|frd t&EE&tH,?E:a-+HH:EIB=.'-.I GAY ROAD FAIJEsIE ATt ncc,GalDIr ,!: u-IrEa a* af an Ea- LOT 61 10,ffi fft /JZ* ;/ufu-r m, CEOn!Eeuaoglllt l i ! .---: SCIIS t'-40'D6g o7fisno ZSoo$@aogF b__w (Os / n1L I /4u -"7 (rt') 4628 MARY ELLEN HEALY () NAME ,STREE') VILLAGE SERVICE NO. METER NO, Llr 1.. 44738t2o % foo s's'qt -w i,r+ fr I t., r WL$q ld<s IE.i I .Z,-*/