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ii <br /> ZC,MIG APP:RWAL <br /> REST HO"Ir, <br /> I have requested a LICENSE' to maintain a AURSIIIG 11&12 X j <br /> (Check one) <br /> at ROUTE 28 &_NOISY HOLE B-OAD O, MASEPFF iron the <br /> Street: City or Tot"m <br /> DEPART.14ENT Or PUBLIC HEALTH and have been advised to clear with the local <br /> zoning authority. <br /> 11ill you therefore kindly check one of the following: <br /> d ; <br /> {� No restrictions !� <br /> i <br /> { ) Restrictions <br /> Signature & Title of Zoning Authority Date � �� <br /> . 1 <br /> {If there is no zoning authority, please have some proper <br /> towm efficial approve, i.e. , Torm <br /> Clerk, Selectman, etc.) <br /> Signature of Applicant <br /> PRTT_)P. NTTRATNC. HOME OF MASHPEE <br /> Tra a Name of Hone <br /> � 4l; <br /> October 11, 1971 <br /> Date <br /> Please return co•ii-aleted forn:to: Department of Public health <br /> Q <br /> ;Avisi_on o': "led.zcal Care <br /> .3ureau of Health racil.ities <br /> 30 Dovl.ston Street <br /> Boston, 'Iassachusetts 02116 <br /> <i <br />