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TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $ -- 00. — y
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL
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Other Permit Fee $---------
Sewer Connection Fee - $
Water Connection Fee $
TOTAL $
Building'Inspector
40 � X6.35 150.00 PAID Div. Public Works
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FORM U LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdict4cm yt``
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: .-Y�A Phone
IACATION: Assessor's Map Number Parcel /� S
Subdivision
Street
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St. Number 9/
*************-***********Official Use Only************************
RECOMMENDATjIIOONS OF TOWN AGENTS:
Conser-vatlon Administrator
Comments
Town Planner
Comments
Food Inspector -health
Aloi�
Septic Inspector -health
Comments
Public WcrYs - sewer/water connections
- driveway permit
Fire Detart:aent
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Date Rejected
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