HomeMy WebLinkAboutBLD-23-004375 .ft
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Tt")\VN OF YAR4iOttlt I
{ WATER DEPARTMENT
t99 Buck Isla d R<sad
as lVest Yrmouth. MA 026'i
N„ Tcicohon ;Euttii 771-7921 • Fat: t;vI3t3 7i-"TM
BUILDING PERMIT APPLICATION FOR
WATER DEPARTMENT SIGN OFF
TRANSMITTAL FORM
BUILDING SITE LOCATION: 3 0 goti<kijeva atoc.
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PROP()sED WORK: P L ar ov e xt+S i t✓Y e, 0'eG k. re.,, ,,t 1d S 4 )itar
APPLICANT: __� ttf{ d �J ` �-._._...__ Lkr` .` '__
ADDREss: z o 3 J &k wD ) t o e--
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RESIDENTIAL AND OR CO\IMERCIAI. BUILDING
water Department: Determines Compliance of Water.\cailahiIit:, and or existing location
Engineering Department: Determines Compliance for Parking and Drainage
Conseil.ation Commission: Dctermines Compliance to Wetlands Act: i.e. If lottsl border ait type of
urtfands.streams.ponds,ricers.ocean.hogs.hogs.marshland. ETC...
Ilcaltli Department; I)etcr ities Compliance to State and Tom II Rep laiions. i.e.
requirements for Septage Disposal and other Public I kal th Actitiites
Eire I kpat-inlent: Determines Compliance to State and limn Requirements for Personal
Safety.Property Protections.i.e.Smoke Detectors.Sprinkler Systems.ete
21-9°4Oct /
APPLICANT SIGN:ITURF; ' DA"IT t
OFFICE. USE: COMMFYI'S ON PERMI"l kPPROVAL OR DENI:11.
142..".....I- VI 0,S 1 7.‘;'.2.
RE VIEWS B1" ATER DIVISION(SIGNATURE) DATE
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SERVICE NO. - 0
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NAME \‘ -ve r
STREET 3 C, _çj +A -7 0
VILLAGE ry C7 ColC. '••••"`s
METER NO. ie-vA/e767 afer) #1745/a2ov;? ,;.2)
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