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SPECIAL PERMIT Date ................................ 19...... <br /> 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 /> ....................................... .............................................. <br /> Name 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)' .........................a........... <br /> .....................'............ ......................... .......................... <br /> ......:......:......................... <br /> ................................................:............:....................... . <br /> ....................................................................................... <br /> ..................................................................................... . <br /> ...................................................................................... <br /> Permit granted (....................) <br /> Yes or-No <br /> ...............................................................:............I.......... <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 /> < .................................................................. . <br /> Use & occupancy? ........................................... . <br /> (Yes or No) (date) Board of Appeals <br />