HomeMy WebLinkAboutMiscellaneous - 124 PHILLIPS COMMON 4/30/2018 124 PHILLIPS COMMON I�y
' 210/058.0-0047-0000.0 CSO tv I;f 01(
FORM - U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all-necessary approval /permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve the
applicant and or landowner from compliance with any applicable requirements.
.....................................................................1....r■u
APPLICANT MOWS 06CIZL PHONA(
ASSESSORS MAP NUMBER LOT NUMBER q
SUBDIVISION - LOT NUMBER
STREET , I I i P S G�n Y-t o n STREET NUMBER I��l
............................................................................
OFFICIAL USE ONLY
RECOMMENDATIONS OF TOWN AGENTS /2�m c2v� L y(s �,-- rc /L
.............................................�.............
DATE APPROVED
CONSERVATION ADMINISTRATOR
DATE REJECTED
COMMENTS
DATE APPROVED
TOWN PLANNER
DATE REJECTED
COMMENTS
DATE APPROVED
FOOD INSPECTOR-HEALU. I DATE REJECTED
DATE APPROVED
SEP EMR-HEAL -
DATE REJECTED
COIvilvfENTS Wit. �5e "Pr
PUBLIC WORKS-SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
DATE APPROVED
FIRE DEPARTMENT
DATE REJECTED
CON vfENTS
RECEIVED BY BUILDING INSPECTOR DATE