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l _ ♦ > �i l -r .A : 1 > J n r <br /> SPECIAL PERMIT rate ................... ............ 19...... <br /> � File ................................ <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 ,o1 <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) ..........................:........... <br /> ................................................................................ <br /> ......................................................................................... <br /> ....................................................................................... <br /> .............................................. ........................ <br /> Permit granted (.........:..........) <br /> Yes or No <br /> ....................................................................................... <br /> Date ...:............................ 19.:.... ....................................................................................... <br /> If permit was granted what other permits <br /> were Issued by the Building Dept? ................................................::.:................ <br /> ToBuild? .............................. .............................. <br /> (Yes or No) (date) .................................................................... <br /> Use di occupancy? .................................................. <br /> .................................................................. . <br /> (Yes or No) (date) Board of Appeals <br />