HomeMy WebLinkAboutWater sign off 4/5/23 3
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BUILDING PERMIT APPLICATION FOR
WATER DEPARTMENT SIGN OFF
TRANSMITTAL FORM
•
BUILDING SITE LOCATION: _..f 1_ S K'QZ_ _..._.__._..__.........._..........._...
PROPOSED WORK: .. ....t
APPLICANT: _4 �L ......Yc �
ADDRESS: a 1 4?Q`d'•1. +10 4 _ _ TI�(� <1 It C 40(4 5-_ _....._
TELPIIONE: �U.� y 6—.=1`1 0 t7
RESIDENTIAL AND,OR COMMERCIAL BL.`ILDING
Water Department: Determines Compliance of Water aca ilabilitp and or et:Wing location
Engineering Depanotent: IA1ennines C mnphmxc for Parking aid Drainage •
Conservation Commission: Determines Compliance to W )and>Net;i e.[lions)border any type of
wetlands.streams.ponds,titers.(Kean.I's.boys,marshland.ETC...
Health Dcpanntem. Determine,Compliance to State and I nwn Regulations,rc.
requiremtxus liar Septage Disposal and other Public I lealth Actis ices
Fire Dc anment: Determines Compliance to State and I own Requirements for Personal
/ Safety.Property Protections,i.e.Smoke Detectors.Sprinkler Systems.etc
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APP fr',CN.•.IGNATURE 1).8TF:
OFFICE USE:CO;IMENTS ON PERMIT APPROVAL OR DENIAL
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REVIEW/I)1W WATER DIVISION(SIGNATURE) DATE