HomeMy WebLinkAboutMiscellaneous - 93 ROCKY BROOK ROAD 4/30/201811
FORM U - VERIFICATION FORM
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.
***********"**�*Ay�q
**Applicant fills out this section*****************
/,/ APPLICANT: I ��Yu�C�'� i�C� 1 Phone
LOCATION: Assessor's Map 6ber --09 0 "Parcel 005-1
Subdivision • Lots) 005 -1 -
Street "I �ff�C� �, .- St. Number_
********************** *O ficial Use Only************************
RECOI 7NDATIONS OF TOWN AGENTS:
Con ervation Administrator
Comments
Town Planner
Comments
Food InsA ctor-Health
,-�'S epeic�Inspectof-Health
Comments
Public Works - sewer/water connections
- driveway permit
Fire Department
Received by Building Inspector
Date Approved V "7
Date Rejected
Date Approved
Date Rejected
Date Approved
Date Rejected
Date Approved
Date Rejected
MAR - 7 1997
Date