HomeMy WebLinkAboutMiscellaneous - 45 LACY STREET 7/12/1996 FORM U - VERIFICATION 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. 61'I 31301
****************Applicant f ' lls out this section*****************
APPLICANT: �G /C� Phone bI—
I 1
LOCATION: Assessor's Map Number UI)5 Parcel /
Subdivision Lot(s)
Street `7�� L �" 7- St. Number --L
Use Only************************
/ RECCOMMENDATIONS OF TOWN AGENTS:
v Date Approved
Conservation Administrator Date Rejected
Comments
Date Approved
Town Planner Date Rejected
Comments
Date Approved
Food Inspector-Health Date Rejected
Date Approved
S� is Spector-He h Date Rejected
Comments 4�u l' G > c 41-el
vL.
Public Works — sewer/water connections
- driveway permit
Fire Department
Received by Building Inspector Date