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.' •'`' TOWN OF NORTH ANDOVER
' LOT RELEASE FOIUI
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SUBDIVISION
`,' ASSESSORS MAP
SUBDIVISION LOT(S) `07 %A 46".2 / 0 s
PERMANENT ADDRESS ASSIGNED BY U.Y.W.
STREET 104 60f,)nly L4A)�5 NU2Tt4 An1DouEtR MA- .
S�cJ/ S, l.( ;tit, UIr- X85- 9�
APPLICANT PRUNE '
•' ' °•• DATE OF APPLICATION
1// '7
TOWN USE BELOW THIS L11IE
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PLANNING BOARD
TOWN PLANNER
CONSERVATION COMMISSION
,, I' v 1 L 1%L& -q --V "
` CONSERVATION ADMIN.
BOARD 0,* I EALT11 GG
HEALTH SANITARIAN
DEPARTMENT OF PUBLIC WORKS
DRIVEWAY PERMIT
SEWER/WATER CONNECTIONS —
FIRE DEPT.
DATE APPROVED
DA'T'E REJECTED
DATE AP
PEtO V E D
DATE REJECTED
DATE APPROVED 2 !/
DATE REJECTED
RECEIVED BY BUILDING INSPECTION
DATE
This form shall be signed by the agents of the Planning and Ilealtli Isoards,
the Conservation Commission prior to the issuance of any building peritits
for the subject lot. This form shall not releive the applicant from tll( I -,
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