HomeMy WebLinkAboutMiscellaneous - 113 HIGH STREET 4/30/2018 (2) f 113 HIGH STREET _
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FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/pests 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: e - orL.) FIA Phone
LOCATION: Assessor's Map Number 67 parcel 7
Subdivision 1 Lot(s)
Street 1-41 C>l-f St. Number _l
************************Official Use Only************************
RECOMMENDATIONS OF TOWN AGENTS:
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Conservation Date Approved /
on Administrator Date Refected
• Comments
Date Approved ' Z �--
Tow Planner Date Rejected
Comments
Date Approved
health Agent Date Rejected
Comments
Public Works - sewer/water connections
- driveway permit
Fire Department
Received by Building Inspector Date
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I CERTIFY TO THE ANDOVER .B.41Vlf ANO I7� T/TLE' //VSURER
THAT TM/S PLAN DEPICTS THE RESULTS OF A CURRENT EXAMINATION OF THE PREMISES
DESCRIBED IN RECORD BOOK G/ps -PA QE 497 Of THE No. ESSEX D/57- REGISTRY OF DEEDS
ANO THAT ALL EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON rAf GROUND
AS SHOWN HEREON.
No res:
I, THIS PLAN WAS NOT MADE FROM AN INSTRUMENT MORTGAGE CERTIFICATION
i SURVEY AND IS NOT FOR RECORDING PURPOSES.
i THE PLAN SHOwS THE CONDITIONS EXISTING AS SKE TCN FOR
OF THE DATE SHowN HEREON. CERT/F/UTION /S
FOR MORTGAGE PURPOSES ONLY PROPERTY pLSEIV c J(- JEr S/4ESgA14
LINES AS SHOWN ARE APPARENT ONLY. F�1'e f'� T�YAT
Z, THE PREMISES DID CONFORM W/TH L 0 CA L f`3 14IC1.r -577�7
ZONING ORDINANCES AT TIME OF
CONSTRUCTION.
=30' L>17-C zz, 0C.7-88
3. THE PREMISES DO NOT FALL WLTH/N A
fLD00 HAZARD ZONE. PREPARED BY eecn '� 1�t/'1C�, P. B.
/f/MG 4550 C/A TES
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