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SPECIAL PERMIT Date ................................ 19...... <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 /> Permit granted (....................) <br /> Yes or No <br /> ....................................................................................... <br /> Date ................................ 19...... ..................................................................................... <br /> �Q <br /> 1 wU -.. <br /> < If permit was granted what other permits <br /> M1 _ were issued by the Building Dept? .................................................................- <br /> y,� <br /> W(? To Build? <br /> .................................................................... <br /> i <br /> Id (Yes or No) (date) <br /> z .................................................................. . <br /> use ' <br /> . ...................... <br /> Board of Appeals <br />