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HomeMy WebLinkAboutWater sign off 4/5/23 Y•..,, i(Y ;' OFYARNit)t'TSs ,t" { ', WATER DEPARTMENT —`1 It r ,.i 9,) 13 is is kla i Ri tad S E`� xr� s1r-t `actyt oath, MA€i,)ta # It R a;? e fax i5oli; t '�D(lti .pm 11 p)-1<llt.`- ail j; ) BUILDING PERMIT APPLICATION FOR WATER DEPARTMENT SIGN OFF TRANSMITTAL FORNI p ( .';} 1t ih BUILDING SITE LOCATION: 6 9,„_TojeA i\r 5_.z._ C Me�(� 1 /"t . PROPOSED WORK: .c.t , � t)m.......m_.__ .. xn geR Q.?. ,'t r ._.____..__._ _ .._.. r. APPLICANT: }� awn `L c-T`s t�%" ADDRESS: ...'�J._.I_To.� _._ ',.U.._.S .t._ac're_1 v M A A2._G` FELPHONE• : .5O _. . .' .? ....5ti_.i.__I __. __.. RESIDENTIAL AND 'OR COMMERCIAL BUILDING Water I)epartment: Determines Compliance of Water Availability and or existing location IttguKerine Department; Determines C ompltance for Parking and Drainage Conservation Commission: Determines Compliance to Wetlands Act: i.e. If Joust border any type of wetlands, streams.ponds_rivers.ocean.hogs,boys. marshland. ETC. I Icaith Department: Determines Compliance to State and Town Regulations.i.e. requirements liar Septage Disposal and other Public health Activites Lire I)epartment: Determines Compliance to State and Town Requirements for Personal Safety. Property Protections,i.e.Smoke Detectors,Sprinkler Systems.eic 5 03 0.3 7 9'111 thk3 62 "-(---- AP ANT SIGNATUREicA00±1.‘,11 1-t.cilo.ciActrcs *5 h i 1,:;)..'-'2" I).-ATE OFFICE USE:COMMENTS ON PERIMIT :APPROVAL.OR t)FNI:AL. +tcli.„,....__ A—C-2--(e.)Z,':-1,.; R1:Vt€A El)BY WATER DIVISION(SIGNATURE) DATE Mk