HomeMy WebLinkAboutMiscellaneous - 107 GRAY STREET 3/18/2003 ���► �-
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FORM U - LOT RELEASE FORM — t g - o
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
*****************************APPLICANT FILLS OUT THIS SECTION***********************
APPLICANT014!At4.r�S PHONES"•ASS'. 9TO I
LOCATION: Assessor's Map Number PARCEL a �O
SUBDIVISION �+ LOT(S)
STREET 1rIZ,A� ST. NUMBER_I<n
************************************OFFICIAL USE ONLY***********************************
RECO/APMENDATIONS OF TOWN AGENTS:
CONSERVATION ADMINIS RATOR DATE APPROVED 3
DATE REJECTED
COMMENTS �� �� lz�Xis to fhe rc,--e ]h,,. ig e W �1
biaf Nof Yri c Sri Is, An -t-O.Lpe. you K r¢.fw- ct�r / r irk of -P,
cJ,
TOWN PLAN NE DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INSPECTOR-HEALTH DATE APPROVED
n DATE REJECTED
SEPTIC INSPECTOR-HEALTH DATE APPROVED
DATE REJECTED
COMMENTS Pew pt cljt) ��J � —
PUBLIC WORKS-SEWER/WATER CONNECTIONS 114
DRIVEWA 'PERMIT_..
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
Revised 9\97 jm
FORM - U - LO' LEASE FORM
INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve the
applicant and or landowner from compliance with any applicable requirements.
Ingo MEMO no an a a am WE Ana MR ME a a am a ME am 0 0 am as 0 a a MEMO am a Ems 0 ago now am MEN am NONE ME Ana
APPLICANT PHONE q-1TL-,v9T So/
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ASSESSORS MAP NUMBER l��� LOTNUMBER C,-�' �P
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SUBDIVISION LOT NUMBER
STREET STREET NUMBER !D'� l
.■.■.■■....■ ■■■. ■..■...■■.■..■...■r■.■■...■■■■■■■■■■■....■.■.■■..■■.■.■.■■ 1i
OFFICIAL USE ONLY
RECOMMENDATIONS OF TOWN AGENTS
DATE APPROVED
CONSERVATION ADMINISTRATOR
DATE REJECTED
COMMENTS
DATE APPROVED
TOWN PLANNER
DATE REJECTED
CON94ENTS
DATE APPROVED
FOOD INSPECT - - DATE REJECTED
DATE APPROVED
..SEP SPE&Ok-HEALTH
DATE REJECTED
CONM4ENTS
PUBLIC WORKS—SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
4
DATE APPROVED
FIRE DEPARTMENT
DATE REJECTED
COMMENTS
RECEIVED BY BUILDING INSPECTOR DATE
