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SPECIAL PERIMT <br />Date................................ 19...... <br />File................................ <br />APPLICATION for SPECIAL PERMIT <br />t �.I.,....00 1.e.1...G......F1A.P.z.4......................... <br />Name <br />...N.or.thaest... corner ... 0....ntersection <br />Location <br />.... f... RG..... 2$...and... i:iA.i. Y.... H01e... Roaa. <br />....................................................................................... <br />r <br />Permit granted (....................) <br />Yes or No <br />Date................................ 19...... <br />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 />(Y& 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 />Bcarj& Appe _Ls <br />