HomeMy WebLinkAboutWater sign off 5/17/23 _ -
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WATER DEPARTMENT RECEivPD
)t79fl:rt:712;;Itl'' •''::' l.'17' -:::" ;' -1E3 UILDING DEPARTME1:
MAY 23 2023 I
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By:
BUILDING PERMIT APPLICATION FOR
WATER DEPARTMENT SIGN OFF
TRANSMITTAL FORM
BI I ED I NG SITE LOCATION: 07- Coda- 54-, ,y-cd4 54:trivettArikt
PROPOSED WORK: ?-e14401€( 4'1-"I' tit,e- tell- aid
APPLICANT: 4,7,..e 144 it ei,
.
ADDRESS: 2-i- 416-4'; 14/71 Ct-v14--e tr tie.1/-c... St ii, ev2-40 4.-
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TELPHONE: 6.Pir-2-7-1 -
_. . __ _ ... .
RESIDENTIAL AND OR COMMERCIAL BUILDING
Water Ikpartment: I ktermines Compliance of Water Axailabilit) and or exist inu location
Fmi,necrine Department: Determines Compliance for Parking and Drainage
Conservation Commission: I ktermines Compliance to Wetlands Act: i c If Ions)border any type of
wetlands.streams, ponds.rivers.ocean. bogs, bo s. marshland. ETC...
llealth Department: Determines Compliance to Staic and Town Regulations, i.e.
requirements for Septage Disposal and other Public I lealth Activites
Fire Depanment: Determines Compliance to State and Town Requirements for Personal
Safely, Property Protections, i.e.Smoke Detectors. Sprinkler Systems.etc
In/al/4
:APPLICANT SIGNATURE I ATE
OFFICE USE: COMMENTS ON PERMIT APPROVAL.OR DENIAL
REVIENVED BY WATER DIVISION(SIGNATURE) DATE
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Joanne Cassidy
NAME .
10793-23 7/15/83
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STRELT 65 South 7.0,x-sot' ,
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