HomeMy WebLinkAboutApplication - 1440 SALEM STREET 8/22/2005 /.2 L
FORM U - LOT RELEASE FORM / 0
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 PHONE4��— G
LOCATION: Assessors Map Number PARCEL
SUBDIVISION LOT (S)
, STREET 1-440 '!� , A21 1( ST. NUMBER
******* *** * ********* ****** ***OFFICIAL USE ONLY* *** ******** ** **
E OM E D N OF TOW GENTS:
.CONSERVATION ADMINiStfafOR DATE APPROVED
DATE REJECTED
COMMENTS W wit ((K` )
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INS ECTOR �4 DATE APPROVED
z � f
r E REJECTED
r
" -.
REA
SE P� INSPEOR= L
CT H E APPROVED -
DATE REJECTED
COMMENTS 01c�
PUBLIC WORKS -SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
Revised 9197 Jm