HomeMy WebLinkAboutApplication - 202 LACY STREET 11/2/1999 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.
*************************'`fig`*APPLICANT FILLS OUT THIS SECTION
APPLICANT ()h" z ,, 1-4, _ PHONE q 7 S IG/6
LOCATION: Assessors Map Number l Q'�5C PARCEL ®6
SUBDIVISION LOT (S) 1
STREET e— C ST. NUMBER 2G Z
** ****** * *** ************OFFICIAL USE ONLY* **************** ******* **
RECOMMENDATIONS OF TOWN AGENTS:
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CO S RVATION ADMINISTRATOR DATE APPROVED c
DATE REJECTED II
COMMENTS L1z Zke
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INSPECTOR-HEALTH DATE APPROVED
DATE REJECTED
*' SEPTIC INSPECTOR-HEALTH DATE APPROVED 'L
DATE REJECTED
COMMENTS
PUBLIC WORKS -SEWERIWATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
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