HomeMy WebLinkAbout2008 Jan 23 - Sign Off Transmittal Sheet - Remodel�. _ _-� _ �. _
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' ��`"""`°`'� PERMTI'APPLICATION SIGN OFF TRANSMITTAL SHEET ,
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To be completed by Applicant.
Building Site I.ocation:1� 9-� //�/�/N .S i ,Sou �.� �/.9.1.n ou,�> Map No.: Lot No.:
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Applicant: � u � �/, �F f�,%.G Tel. No.: o J�- 2� )6d
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Address: 3 �/ ! (_�rr� S/�a.0 �� /�ii. � /�'IA,fJ;�rr S /jji//Date Filed: i ( � Gg
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**I,fyou would like e-mail notification ojsign off,please pravide e-mail address: 1B J S S �'�JC �C u M
OwnerName: /�-TL �=qL �SrA;r �A,cr�r' 2SH -�
Owner Address: ,�Z 3 /I?f;N�e-w S /` �-- � Owner Tel. No.: SD)'- S�L— —
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RESIDENTIAL AND/OR COMMERCIAL BUILDING �
HEALTI�I DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
Please submit four (4) copies of plans, to include:
(1.) Site Plan showing existing buildings, water line locafion,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all existing and proposed)—
Note:FToor plans not required for decks, sheds, windows„roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: DATE: p S'
PLEASE NOTE
CO1vIlvIENTSJCONDTi'IONS: '
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