HomeMy WebLinkAboutWater sign off 4/19/23 WATER DEPARTMENT
99 Buck isand Road
k4 VA', SSE 4' tA'eg Yarrnouill. MA 026-
T, `�ahtsne: fit,`, 77 1-:'9=i ' I av: i at1tS 7-i 99b
BUILDING PERMIT APPLICATION FOR
WATER DEPARTMENT SIGN OFF
TRANSMITTAL FORM
BUILDING SITE LOCATION: 't 7 La,4 "Lcite, TL7__
PROPOSED WORK: a 2 / IA:We
APPI.[CA NT: ( ' c;I -.d / (5'c-'/ �Ul rod--,5
ADDRESS:
ftLPHONE: , d 2 c. ' �- ll/ /9--
RI SIDL-N HAL AND OR CON/I\II:RCIAL BUILDING
\\"atcr Ucpartment: Determine:,Compliance of Water \\atlahilitp and or existing location
Iingineerimz Department: Determines Compliance for Parking and Drainage
C'on:cnation Commission: Determines Compliance to Wetlands Act: i e II Iot(s)border an type of
\\etlands,streams.ponds,ri\ers,ocean,bogs.Foy..marshland. FTC..
IIcaltli Department: Determine,Compliance to State and Io\\n Regulations: i_c.
requirements tier Septage Disposal and other Public I lealth Acti\ttes
fire Department: Determines Compliance to State and Town Requirements for Personal
Safely.Property Protections,i.e.Smoke Detectors, Sprinkler Systems,etc
APPLICA SIGNATURE D tTE
OFFICE USE:COMMIE.'' ON PERMIT APPROVAL OR DENIAL
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RE:VIE\1'E. BY WATER DIVISION(SIGNATURE) DATE: