HomeMy WebLinkAboutMiscellaneous - 111 MARIAN DRIVE 10/1/1993 FORM U - ICT raMMSE 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 local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: 1 \�.: �:,-
' ���� ��' '� � Phone
LOCATION: Assessor' s Map Number /L7 Vi �� Parcel
Subdivision Lot,(s) �•..� .
Street fiY"i ;� ` ,:v�_ 1 \,'t,�a�{', St. Number
************************Official Use
RECOMM ATIONS OF TOWN AGENTS:
Date Approved
Conservation Administrator Date Rejected
Comments
Date Approved
Town Planner Data Rejected
Comments
Date Approved
Health Agent Date Rejected
Comments �iti/5
Public Work= - sewer/wamar connections
- drivewav pe=-it
Fire Depar--e_^.-
Received by Building Inzmectnr Date