HomeMy WebLinkAboutWater sign off 2/22/23 TOWN OF Y,\0,1( P.lil
WATER DEPARTMENT
99 Bock Island FloJd
16.;;;n5-E/c(74 West Varrnouth„MA 0267.i
lelephone l5M 771-7921 • Fav l';06 7717998
BUILDING PERMIT APPLICATION FOR
WATER DEPARTMENT SIGN OFF
TRANSMITTAL FORM
BUILDING SEE LOCATION: 6 -,..";-? (-1-3 ').:..? ,31?Y'r'ri . )!,' ;,, I) r
PROPOSED WORK: CLA ,',. 0,.'<e"
APPLICANT: (/..:!..h r 15 f7 Y1 •(-2 L.0 fr 1
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ADDRESS: ,-.',„ 21 (f; Po r--F m i.\ 0 24
TELPHONE: )'''5 • 2'??.-
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RESIDENTIAL AM) OR COMMERCIAL BUILDING (_ L4-„,--4
Water Department: Determines Compliance of Water Availability and or existing location
Engineering Department: Determines Compliance for Parking and Drainage
Conservation Commission, Determines Compliance to Wetlands Act; i.e. If lot(s)harder any type of
wetlands,streams,ponds,rivers,ocean,bogs,boys, marshland, ETC..
Health Fkpartment: Determines Compliance to State and Town Reintlations,i.e.
requirements for Septage Disposal and other Public Health Activites
Fire Department: Determines Compliance to State and Town Requirements for Personal
Safety, Property Protections,i.e.Smoke Detectors,Sprinkler Systems,etc
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APPLICANT SIGkATURE
DATE
OFFICE USE: COMMENTS ON PERMIT APPROVALL
OR DENIA
idly 1,1)ve 4 .41-- ear IL,- de otAt)‘
till te., .1.7.44 0 io 04eittte_tAJ p Loietf 6.1-- /t/e AJ t-iy-frab-vale ft/
ern /ere rOf iiire 1•VA're-.1(. -i-c i-V1 41( ie.,,LeICAKI770?-11 .
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REVIEWED WATER DIVISION(SIGNATURE)
DATE
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