HomeMy WebLinkAboutMiscellaneous - 255 HAY MEADOW ROAD 9/25/1992 FORM U - LOT RELFASE 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.
**************L*�*Appllicant fills out this section*****************
APPLICANT: /)�hil�T� �SIP✓ Phone
LOCATION: Assessor' s Map Number / �� Parcel �� c��� 4n0•
Subdivision Lot(s)
Street St. Numberc�
************************Official Use Only************************
RECOMMENDATIONS OF TOWN AGENTS:
Date Approved
Conservation Administrator Date Rejected
Comments
Date Approved [> --
own P1 nner Date Rejected
Comments
1� 1: Date Approved -�
Health Agent Date Rejected
Comments
Public Works - water connection
- driveway permit P �O,e� &Vtntc
2
Fire Department ? -� ✓''�° � �, ' '� 3- ^/-�- %`�/✓°�
Received by Bui ding 3-nspector Date
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