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SPECIAL PERMIT Date . . .. . . .. .. . . . 19. . . . <br /> File .. . . . . . . . To Building Inspector <br /> A <br /> Application for Special Permit You are hereby,-authors to issue <br /> a "Special Perrtiit' for t •:s, applica- <br /> tion for signature Sof th -B-ard of <br /> Appeals and are.herea ad,, that <br /> this application hassi�recei+ved the <br /> . .. . . . . . . . . . . . . . .. . . .. .. . .. . . . . . .. . . approval of ttie Board of appeals. <br /> Name <br /> If any conditions a7^e rtten below <br /> . . . . . . . . . . . . .. .. . . . . . .. . .. .. . . . . . . . . you are requestgd that they <br /> Location are complied -wd-t included in <br /> permit. <br /> . . .. . . . .. .. . . . ... . . . . .. . .. .. . .. .. . . . . <br /> Conditions (if any) . . .. . . . .. . .. . . . <br /> .. .. .. .. .. . . . . .. .... . .. ... .. . . . .. .. . <br /> .. ........ ... . . .. . ... . . . . ... . . . ... . <br /> . . ... . .. . .. .. . .. . . .. . . .... . .. . .. . . . <br /> Permit granted ( ) <br /> Yes or No <br /> . . . . . . .. .. . . . . .. . .. .. . .. . . .. . . . . . . . <br /> Date .. .. . .. . . .. . ... .19. .. . <br /> . . .. . . .. ...... . . . . . . .. . ... .. . ... . . . <br /> . . . .. . . . . . . . . . . . . . .. . ... .. . .. . .. . . . <br /> If permit was granted what other . . .. .. . .. . .. . . . .. . . .. . . . . . .. . .• • • • • <br /> permits were issued by the Building <br /> Department?. <br /> To Build? <br /> (Yes or No) (date) . . . . . . . . . . .. . . .. . . . .. . .. . .. . .. . . . . . <br /> Use & Occupancy? .. . . . . . . .. . . .. . . . . . . . . . . . . . . . . . . . <br /> (Yes or No) (date) Board of Appeals <br />