HomeMy WebLinkAbout2020 Sign off Transmittal - Interior Renovations 1.,....:,,
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HEALTH DEPARTMENT..- /
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=.—„aE PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET „, '
To be completed by Applicant: - ,4,
Building Site Location: f! W/A) 'e Jf ee AV(
Proposed Improvement: Q t✓Yy 04E LA-)cz tjtjaMfe vi 1 114-h e vl A Li U/46,
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Applicant: S 6t � Tel.No.:
Address: bli /4tifl7i a W i \ ' J11471 , (2 n Date Filed: C5 7V--
**If you would like e-mail notification of sign off please provide e-mail address: 4041.S bA y W 1 (.,YJejritct ,G d kb
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Owner Name: / 1 f e It z l efkf
Owner Address: Owner Tel.No.:
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;
AUG 2 7 2020 (2.) Floor plan labeling ALL rooms-within building
(all existing and proposed)-
HEALTH DEPT. Note:Floor plans not required for decks,sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: 64/144.../ .W......... DATE: C‘i 2 1/1-10 7,0
PLEASE NOTE
COMMENTS/CONDITIONS: _
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AUG 2 72020
HEALTH DEPT.