HomeMy WebLinkAboutMiscellaneous - 110 LANCASTER ROAD 4/30/2018 (2) 110 LANCASTER ROAD -
210/104.D-0166-0000.0
I
FORM U - LOT REIZASE FORM K
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.
****************Applicant fills out this section*****************
APPLICANT: -2�'�.��y.�1 �C d �c±1�� �� Phone
LOCATION: Assessor's Map Number - Parcel
Subdivision 61/9-57,49 Lot(s) 32
Street _rte 19 /--d 4 S J��n X�. St. Number110
************************Official Use Only************************
RECOMMEENDATIONS OF TOWN AGENTS:
G Date Approved ��
Conservation Administrator Date Rejected
Comments
Date Approved �" Q
Town Plann r Date Rejected
Comments
Date Approved
Food Inspector-Health Date Rejected
117 L) YIN, Date Approved
Septic nspector-Health Date Rejected Vi
Comments
(/n�10-7
connections {-
Public Works sewer/water
driveway per-mi i- -9�
Fire Department
Received by Building Inspector Date