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SPECIAL PERMIT Date . . .. . . .. . . .. .i9: . . . <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 beloo <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 /> ( ) .. .. .. . .. . . .. . . . . . . ... ...... . .. . . . . <br /> Permit granted . . .. ... . <br /> Yes or No <br /> . .. .. . . . . .. . . . .. . . . . . .. . . . . .. . . . . . . <br /> C.- <br /> Date .. . . . . . . . . .19.... <br /> If permit was granted what other . . .... . .. . .. . . . . . . . .. . .. .... ..•• • • • <br /> permits were issued by the Building <br /> Department?. <br /> To Build? . . . . . <br /> (Yes or No) (date) . . . . . . . .. I . .. . . . . .. .... .. . . . . . .. . . .. <br /> Use & Occupancy? . . . . . . .. .. . ... . . . . . . . .. .. . ... . . . . . . . . <br /> (Yes or No) (date) Board of Appe`z.a <br /> 0 <br /> y <br />