HomeMy WebLinkAboutMiscellaneous - 240 GRAY STREET 11/5/2004 FORM U - LOT RELEASE FORM
f
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 .L C' ���� _ PHONE f/
LOCATION: Assessor`s Map Number l 07 b PARCEL '4�
SUBDIVISION LOT (S)
STREET_ C f cz-� ST ST. NUMBER�d
OFFICIAL USE. ONLY*
1CO� E A 10' TOWN A E S:
C SERVATION AD NISTRATOR DATE APPROVED -
DATE REJECTED
COMMENTS �/ �Y` is
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS /l 1 (� ' lL LG� i j
FOOD INSPECTOR-H TH DATE APPROVED
DATE REJI.CTED
SSE IC INSP CT -H LTH DATE APPi ROVED
� r. /�� ty
DATE REJECTED z
..... . ...... ..
COMMENT 044-t
PUBLIC WORKS-SEWERIWATER CONNECTIONS � ' J. lfl _
DRIVEWAY PERMITf��r.� �
DIRE DEPARTMENT QA,f,,,Q kA ,*,((' to k 0/6%,,,T &-wic
RECEIVED BY BUILDING INSPECTOR DATE
Rev(aed 8197 jm