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SPECIAL PERNIIT <br />Date................................ 19...... <br />File................................ <br />APPLICATION for SPECIAL PERMIT <br />................................................. :..................................... <br />Name <br />............................................................................ I ......... <br />Location <br />To Building Inspector <br />You are hereby authorized ,to issue a <br />"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 />If any conditions are written below, you <br />are requested to see that they are complied <br />with, and included in permit. , <br />Conditions (if any) <br />........... .................................... :....................................... <br />...................................................................................... <br />....................................................................................... <br />