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SPECIAL FERMIf Date . . .. . . .. . . . . . :9. . . . <br /> File . .. .. .. . . ?o Building Inspector <br /> You are hereby authorized to issue <br /> Application for Special Permit a "Special Permit for this applica- <br /> tion for signature of the Board of <br /> Appeals and are hereby advised that <br /> this application has received the <br /> ,,, , , approval of the Board of Appeals. <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 /> .. .. .. .. .... ... . .... Conditions (if any) . . ... . . ... .. . . . <br /> .. ........ ... . . .. . ... . .. ... . . . .. . . . <br /> .. .. .. .. . . .. . . .. . . .. . ..... . .. . . .. . . <br /> . .... . . . . ... .. .. . . .. .. . .. ... . .. . . . . <br /> Permit granted ( .. ... .. .. .) <br /> Yes or No <br /> .. .. .. . .. . . . . . . .. . . . . . .. . . . . ... .. . . <br /> Date .. . . . . . . . ... . .. .19. ... <br /> . . ... . ... . .. .. .. . ... . . ... . .. . . .. . .. <br /> If permit was granted what other . .... . .. . . .. . . .. . . . . .. . ... . .. . .. . . . <br /> permits were issued by the Building <br /> Department?. <br /> • . . ... . . . . ... . . .. . . . . .. . ... . .. . .. . . <br /> To Build? . . .. . . ... . <br /> (Yes or No) (date) . . . .. . . .. . . .. . .. . . ... ... .... .. . . . . . <br /> Use & Occupancy? .. . . .. . . . <br /> t- (Y " " ' Board of Appeal, <br /> (Yes or No) (date) <br />