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SPECIAL PERMIT Date ................................ 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 of <br /> Appeals. <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 /> r <br /> ' ............................................................:........................ . <br /> ....................................................................................... <br /> ..................................................................................... . <br /> ...........................................................I........................... <br /> Permit granted (....................) <br /> Yes or No <br /> Date ................................ 19...... ....................................................................................... <br /> f , <br /> ? r <br /> If permit was granted what other permits <br /> �t were issued by the Building Dept? ................................................................. <br /> To Build? ....... ...................... <br /> .................................................................... <br /> (Yes or No) (date) <br /> u ancy? . ...................... .................................. <br /> ,. <br /> date) Board of Appeals <br />