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SPECIAL PERMiT Date . . . . . . . .. . . . .19. . . . <br /> File .. ... . . . . <br /> I� ��• - 70 „wilding Inspector <br /> Application for Special Permit You are hereby authorild to issue. <br /> a "Special Permit' for "is appliea <br /> tion for signature of Me Board of')' <br /> Appeals and are hereby$Tdvised that' <br /> this application has're�ived the.. <br /> . . .. . approval of the Board o Appeals., <br /> " <br /> ' Name <br /> If any conditions are written below <br /> you are requested to see that they <br /> Location are complied with, and included in <br /> permit. <br /> .... . . . . .. . . . . .. .. . . .. .. .... . .. . . . . . <br /> Conditions (if any) . . .. . . . . .. . . . . . <br /> S Permit granted ( . .. ...... . <br /> ) <br /> Yesor No . .. . .. . . .. . . <br /> Date .. . . . . . . . ... ... .19. .. . <br /> . . .. . . .... .... . . .. . ... ... . ... . .. . . . <br /> Ifpermit was granted what other . . .. .. . .. . .. . . . ... . ... . ... .. . . •• • • • <br /> permits were issued by the Building <br /> Department?. <br /> To Build? . .. .. . .. . . <br /> (Yes or No) (Nate) . . . . . . . . . . . .. . . . . . . .. . . . . . . . . . . . . . . <br /> Use & occupancy? Board of Appsa3.1 <br /> (Yes or No) (date) <br />