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SPECIAL PERMIT Date ........................ 19...... <br /> File ................................ <br /> You are hereby authorized to issue a <br /> APPLICATION for SPECIAL PERMIT "Special Permit" for this application for <br /> a , signature of the Board of Appeals and are <br /> hereby advised that this application has <br /> received the approval of the Board of <br /> e Appeals. <br /> ` .......................................Name....................................... <br /> If any conditions are written below, you <br /> R are requested to see that they are complied <br /> a with, and included in permit. <br /> Location <br /> ° $ Conditions (if any) ...................................... <br /> .............................................................................. ....................................................................................... <br /> ....................................................................................... <br /> ....................................................................................... <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 /> To Build? .......... <br /> .......................................................... <br /> (Yes or No) (date) <br /> .................................................................!. <br /> Use & occupancy? ...:............................................... <br /> (Yes or No) (date) Board of Appeals <br />