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HomeMy WebLinkAbout2010 Mar 15 - Sign Off Transmittal Sheet, Plans - Sun Porch , -�,,':?r�` sAa„ �v^*.",�h7<'f`..,`.a. ,.. • „ t:.. .�-,...^rrstz,. - .;a'^��.,.,. ;< . .:�. �. ,. . �..2 ..�., . � ,,., .. - - �,x� � , , � , . . ., , . -, . . � -,, c,.. ,,. ....� - . ,... . ...v. .- , . �, ,. ,: b . � . . . .,:. ..... . . .. -.. . ...., .. . . . , . .. . .:: �, ...,-. ...,. . , .. ,.. � �.. .. ,� � � . . . .. - .. � � . . �� I ' ��`�Q ���� �� �1�►.��a..��� I y �A►I�T� 1��P�'T�E�iT' �„�,� �� ,� � : � � �� � � � � � � ��`°� �'� P�R�+iIT APP�GA�t3N SI�N QFF Ti�t�N51��T�'AL S�EET Tn be completed by Applicarnt: Buildin Site Location: �� 1S � � Ma N : g �_ � p o- L o t N o.: Proposed Improvement: ` '�(,�h ��YE_h 1 `� x�� -- U �n 4��..�. `�-t-`�� APplicant: U�'f'1 Gt f �l� ' Tel. No.: �g `��/7 '��� � Address: t1�1' �-' I `� (��� DateFiled: - � � **If you would like e-mail notification of sign o,�;please provide e-tnail address: � "'�'�/r(f'���o�0 Owner Name: ✓Y1G1S a Jf1 I� 1 � J' / / n �� 't0(s�-7-� i Owner Address:� �T �YS�j� � UXJ1�/Gf mf'�' Owner Tel. No.: a�'i+'C7 � ; _..........._....._._............-�----.....---�--......................_.........---�-------�--------...............................-----� ; ------------�..............................................................�----�---.............__.._...................: .....-�----��--��.................._...._....-�------.._.._._.... f ; � R�SIDENTIAL AN�/OR COA�tMERCIAL BUILDING ' HEALTH DEPARTMENT: De#ermines Compliance to State and Town Regulations; i.e., R�uirements , For Septage Disposal and other Public Health Activities. Please submit four(4) copies of plans, to include: (1.) Site Pl�n sh��ving e�isting buildings, w�ter line loc�tion, and septic system location; ` (2.) F1oor plan labeling ALL rooms within building �`� , (aU e$isting and proposed)= Note:FToor plans not requi�d for decks, sheds, windows, rior�ftKg; (3.) If necessary, Title 5 applicatian sigfled by license�i instsller with fee. ...........................�---....---------.._............................. .. ...----_......._.....------------�-----------_..._:---..... ...-------------------�,........-------...._...---....-----.........-�-------........--------..._...............................:.--��--�------.._........_.__ REVIEWED BY: DATE: � ,� ���� FLEASE NOTE C011�IlV�ENTS/CONDITIONS: