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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 /> .......................................'............................................... <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 /> c . <br /> Location <br /> Conditions (if any) ...................................... <br /> ......................................................................................: <br /> ....................................................................................... <br /> ................................................................................. <br /> .............'`........................................................................ <br /> ................................................................................. . <br /> ....................................................................................... <br /> ..................................................................................... . <br /> S. <br /> Permit granted (....................). <br /> Yes or No <br /> ....................................................................................... <br /> Date ................................ 19...... ...........:............................................:.............................. <br /> a eN If permit was granted what other permits <br /> were issued by the Building Dept? .................................................................... <br /> r <br /> s Qp <br /> ToBuild? .............................. .............................. <br /> � (Yes or No) (date) ...................................................... <br /> C J <br /> .................................................... ..... <br /> Yes .... . <br /> Use & occupancy? ..........or......No...................dat......e......... <br /> Board of Appeals <br /> — ( <br /> � <br /> 7 <br />