HomeMy WebLinkAboutMiscellaneous - 346 SALEM STREET 4/30/2018 (2)�4
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INSTRUCTIONS: This form is used to verify that all necessary a rovaW e
Boards and Departments having jurisdiction have been obtained. ve
. This'does not belie m
' the applicant and/or landowner from compliance with any applicable or requirements.
4 ments.
**APPLICANT FILLS OUT THIS SECTION
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APPLICANT
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LOCATION: Assessor's Map Number
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SUBDIVISION
LOT (S)
STREET ;�/}a y� .
ST.NUMBER
'ATION ADM
COMMENTS
AGENTS:
DATE APPROVED
DATE REJECTED
TOWN PLANNER DATE.APPRQYED
DATE REJECTED
CCRxPJIEiqTS
FOOD IN
,�SpE%OR-HEALTH
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COMMENT
DATE APPROVED
DATE REJECTED
DATE APPROVED y
DATE REJECTED
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PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR
DATE_
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SEPTIC SYSTEM INSPECTION FORM
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DATE INSPECTED
PROPERLY FUNCTIONING? D N
WEATHER CONDITIONS
COMMENTS:
WATER QuALI i Y TESTES?. 'RESULTS?
DYE TEST PERFORMED? Y .N
DATE?
SKETCH: