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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 /> ....._..._................................... ...................... <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) .........................I.......... . <br /> .............................................................................. <br /> ....................................................................................... <br /> .........................................._..:.......... ...... ............ <br /> ............................................................................... <br /> ..........................................._.......... ............................. . <br /> .............................................................................. <br /> ..........................................._....:............._............... . <br /> ...................................................I........................... <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 /> (Yes or No) (date) <br /> Use & occupancy? Y <br /> A• I3 Y <br />