HomeMy WebLinkAboutMiscellaneous - 46 RALEIGH TAVERN LANE 12/9/2004 FORM U --LOT RELEASE FORM
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***********************
APPLICANT C'/` L° `�`i' '� ( �y ti -� PHONE
LOCATION: Assessor's Map Number -t PARCEL—IL1
SUBDIVISION LOT (S)
STREET Lc C V11 IU ST. NUMBER
*****"""OFFICIAL USE ONLY *****
RE O AT S OF TO ENTS:
CO ERVATION DMINISTRATOR DATE APPROVED '
V DATE REJECTED
COMMENTS IV,
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INSPECTOR-HEALTH DATE APPROVED
DATE REJECTED
t / "S I INSP OR-HEALTH DATE APPROVED
DATE REJECTED
COMMENTS
PUBLIC WORKS -SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
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— FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and --partments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
**'A�'PLICANT FILLS OUT THIS SECTION
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APPLICANT5A/(//�Wl� PHONE �c -;?5&
LOCATION: Assessor's Map Number PARCEL
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ST. NUMBERV
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REC MMIENDATIONS OF TOWN AGENTS:
CONS R ATION ADMINISTRA OR DATE APPROVED
DATE REJECTED
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TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
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FOOD INSPECTOR-HEALTH DATE APPROVED
DATE REJECTED
L<SEPt INSP OR-HEALT14 DATE APPROVED z
DATE REJECTED
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COMMENTS
PUBLIC WORKS -SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
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