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Date . . .. .... . ...19.. . . <br /> File To Building Inspector <br /> Application for Special Permit <br /> You are hereby authorized to issue <br /> ., a "Special Permit' for this applica- <br /> t "" tion for signature of the Boardof <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 /> (if any) ..... ... ... . <br /> ..... ......... <br /> Permit granted .. ..... . <br /> Yes or No <br /> . .... ... . .. .. . . ..... . .... . ... .. . . . <br /> Date ........ ..... ...19.... .... ............ ..... ... . .. . ... . . . f <br /> Ifpermit was granted what other ...... .................... ... ... . . . <br /> permits were issued by the Building <br /> Department? <br /> ..... . ............. ... ... .. .. . . . . .. <br /> To. Build?-...0.000.. . <br /> (Yes or No) (date) ..... . . .. . I .. . . . . . ... ... .. ... ., . . . . . <br /> Use & Occupancy? .. ............... ......... ... .. <br /> - (Yes or�No) (date) Board of Appeals <br />