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SPECIAL PERMIT <br />Date................................ 19...... <br />File................... :............ <br />APPLICATION for SPECIAL PERMIT <br />........................................................................ <br />Name <br />............ ................................................................... :....... <br />Location <br />Permit granted (....................) <br />Yes or No <br />Date................................ 19...... <br />z_ If permit was granted what other permits <br />were issued by the Building Dept? <br />ToBuild? .............................. .............................. <br />! (Yes or No) (date) <br />Use & occupancy? .................................................. <br />(Yes or No) (date) <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 />Board of Appeals <br />