HomeMy WebLinkAboutMiscellaneous - Fernwood StreetFORM - U - LOT RELEASE FORINT
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.
APPLICANT �U/��� rG�'f� PHONE
ASSESSORS MAP NUMBER
LOT NUMBER ,f5'
SUBDIVISION LOT NUMBER
STREET �•� SJ— STREET NUMBER D6
OFFICIAL USE ONLY
............................................................................
RECOMMENDATIONS OF TOWN AGENTS
1 x 9. 0 .. 0 .. / a 0 9 t\.\ ...... 8 5 0. 0.\ .. \\\ a 0 00.00■■ 0 z 2 a a 0 0 0 N x N 0 0 E 0 M a a E a a a a 0 a E 0 0■0
DATE APPROVED
CONSERVATION ADMINISTRATOR
DATE REJECTED
COMMENTS
DATE APPROVED
TOWN PLANNER
DATE REJECTED
COMMENTS
DATE APPROVED
FOOD INSPECTO�iEAL�I
DATE REJECTED
DATE APPROVED
SEPTIC SP R -HEAT.
�= �
DATE REJECTED
COMMENTS Lam_
z -vim L
PUBLIC WORKS - SEWER / WATER CONNECTIONS
DRIVEWAY PERMIT
DATE APPROVED
FIRE DEPARTMENT
DATE REJECTED
COMMENTS
RECEIVED BY BUILDING INSPECTOR DATE