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SPECIAL PERMIT Date . . .. .... . ...19. . . . <br /> File ... .. .. . . To Building Inspector <br /> Application for Special Permit You are hereby authorized to issue <br /> a Special Permit for this applica- <br /> tion for signature of the Board of <br /> Appeals and are hereby advised that <br /> this application has received the <br /> . ..... . ... ..... ....... ... .. .. .. approval of the Board of Appeals. <br /> Name <br /> If any conditions are written below; <br /> you are requested to see that they <br /> Location are.complied with, and included in <br /> permit. <br /> . ... . .... .... .... .. . . .... . ....... .. .. <br /> Conditions (if any) ..... . ...... ... <br /> ... <br /> . .. .. . .... . . . ..... . . .. ... . . ....... . § . .... ........ .. ....... .... .. . . . <br /> .. . .. . .. . . .. . . .. . ... ... .. . .. . . .. .. . <br /> Permit granted ( . . .. . .. . . .) <br /> Yes or No <br /> Date .. ... ... . . .. . .. .19.... <br /> . . . ... . ... . .. . . ... ..... .... ... . .. . . . <br /> Ifpermit was granted what other . ..... . . . . . . .. . ... . ... .. .. . . . . .. . . . <br /> permits were issued by the Building <br /> Department? <br /> . . ........... . . ...... . ... ... .. . . . . . <br /> To Build? .. .... .. . . <br /> (Yes or No) (date) ..... . ...... .. .. ........... .. . . . . . . <br /> Use & Occupancy? .. .. . . .. .. .. . ... ... . . . <br /> " )(" ) Board of Appeals <br /> - (Yes or No) (date) <br />