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SPECIAL PERMIT Date ................................ 18...... <br /> File ................................ To Building Inspector; <br /> You are hereby authorized to issue a <br /> APPLICATION for SPECIAL PERMIT "Special Permit" for this application for <br /> signature of the Board of Appeals and are <br /> hereby advised that this application has <br /> received the approval of the Board of <br /> Appeals. <br /> .......................................Name....................................... <br /> If any conditions are written below, you <br /> are requested to see that they are complied <br /> with, and included in permit. <br /> ......................................................................... <br /> Location <br /> Conditions (if any) ....... ..................._......... <br /> ....................................................................................... ....................................................................................... <br /> _ <br /> ................................................................ ......... <br /> .. <br /> ..................................................................................... <br /> _................................................................................... . <br /> ................................................................................. <br /> ..................................................................................... . <br /> ......................................................................._.......... <br /> Permit granted (.................. <br /> Yes or No <br /> ....................................................................................... <br /> Date ................................ 19...... . ............................................................... ..................... <br /> If permit was granted what other permits <br /> were issued by the Building Dept? ..............................-,.................................. <br /> To Build? .............................. .............................. <br /> .................................................................... <br /> (Yes or No) (date) <br /> ...................................I.............................. . <br /> Use & occupancy? ....................................... <br /> (Yes or No) (date) Board of Appeals <br />