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`w�a+kn 0, <br /> - TE ORARY,SIGN $'ERMFT <br /> TOWN OF MASHME <br /> APPLICATION_ <br /> Date he Permit No. <br /> I <br /> PLEASE PRINT LEGIBLY ` <br /> Naive of Applicant: ea"'j---6 d's C124 T Telephone:i <br /> - <br /> Name of Event: <br /> Date(s)of the Event:_ 'J r Date to be Removed; <br /> Dimensions of Sign(s): Length _ Width 1 t � Height Area <br /> Number and Location(s)of Sign(s): <br /> Th .ru S Gfr6"ICV 7 o`er <br /> I declare under the penalties of perjury that the statements herein contained are true and correct to the best of my knowledge and <br /> belief. I hereby declare that I have read the requirements for the installation of a Temporary Sign and will abide by said regulations . <br /> and will remove said sign(s)b he time frame approved,and thus hereby signed under the pains and penalties of perjury. <br /> Applicant's Signature Date I )Z,),I <br /> Town Manager Approval Date <br /> Board of Selectmen Review Bate of Meeting: <br /> CIRCLE ONE <br /> APPROVED DISAPPROVED <br /> Rev.8/1S/16 <br />