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SPECIAL PERMIT Date ................................ 19...... <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 /> .................................................................................... <br /> Location <br /> Conditions (if any) ...................................... <br /> ....................................................................................... <br /> ....................................................................................... <br /> .................................................................__,_................. <br /> - ....................... <br /> .............................................................. <br /> -. <br /> ............................................................a....................... <br /> . . <br /> ....................................................................................... <br /> - <br /> ......................................................:................ <br /> .............. . <br /> ....................................................................................... <br /> Permit granted (....................) <br /> Yes or No <br /> ....................................................................................... <br /> Date ................................ 19...... ..................................................................................... <br /> b <br /> 4 r <br /> � If permit was granted what other.permits <br /> were issued by the Building Dept? .................................................................... <br /> ToBuild? .............................. ............................... <br /> (Yes or No) (date) <br /> ...............__....... .... ....._.............._ ......... . r <br /> ? .................................................. Board of Appeals <br />