HomeMy WebLinkAboutWater sign off 4/5/23 FD -0)3- I t a7
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OFYAR TOWN OF YAR.titOtlTtl TNV - ..-N,
�� WATER DEPARTMENT 'a-+ - 11-1 I
t7 ��' 99 Buck Island Road
wntuo�xc, West Yarmouth. MA 02673
Telephone: 'SW) 771-7921 • Fax: 1608)7'1-7998
BUILDING PERMIT APPLICATION FOR
WATER DEPARTMENT SIGN OFF
TRANSMITTAL FORM
BUILDING SITE LOCATION: $'0 O /T 6 A
PROPOSED WORK: __$%, i I ci net,- c,/-1J/�. -retril,- 7 _y` .4e c/r e o r'
APPLICANT: r- t e-\--k-a Corp
ADDRESS: It fl IN a 5 h y+O,l S' /.ck ifritr-P f. e O ?I
TELPHONE: 7 ( 5 R q 5' 3 1 5
RESIDENTIAL AND:OR COMMERCIAL BUILDING
Water Department: Determines Compliance of Water Availability and or existing location
Engineering Department: Determines Compliance for Parkin and Drainage
Conservation Commission: Determines Compliance to Wetlands Act;i.e. II lots)border any type of
wetlands. streams.ponds,rivers,ocean,bogs,boys. marshland.ETC...
E Eealth Department: Determines Compliance to State and Town Regulations.i.e.
requirements for Septage Disposal and other Public Health Activites
Fire Department: Determines Compliance to State and Town Requirements for Personal
Safely.Property Protections, i.e.Smoke Detectors,Sprinkler Systems,etc
API�PC 3• �'7. �)
LICANT SI GNATUR . DATE
OFFICE USE: COMMENTS ON PERMIT APPROVAL OR DENIAL
REVIEWED BY WATER AT£R DIVISION(SIGNATURE) DATE