HomeMy Public PortalAboutBuilding Waiver Form
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11/21/2019
Permit #:
BUILDING WAIVER SIGN OFF SHEET
To be completed by Applicant:
Building Site Location Map Parcel
Proposed Improvement:
Zone II: Y / N DCPC: Y / N Town or Well water:
Applicant: Phone #:
Address: Date Filed:
**If you would like e-mail notification of sign off, please provide e-mail address:
Owner Name: Phone:
Owner Address:
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements for
Septage Disposal and other Public Health Activities.
Please submit one (1) copies of plan, to include:
(1) Site plan showing existing buildings, water line location and septic
System location;
(2) Floor plan labeling ALL rooms within building (all existing and proposed)
Note: Floor plans are not required for decks, sheds, windows, roofing;
(3) If necessary, Title 5 application signed by licensed install er with fee
(4) If review is for a DWCP application, 3 sets of site plans are required)
Reviewed by: Date:
PLEASE NOTE
Comments/Conditions:
Town of Brewster
2198 MAIN STREET Health Department
BREWSTER, MASSACHUSETTS 02631-1898
Amy L. von Hone, R.S., C.H.O. Director
PHONE: 508.896.3701 EXT. 1120
FAX: 508.896.4538 Sherrie McCullough, R.S.
brhealth@brewster-ma.gov Assistant Director
WWW.BREWSTER-MA.GOV Tammi Mason
Senior Department Assistant