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Home My WebLink AboutForm U - Lot Release Form 1998 - Miscellaneous - 103 TUCKER FARM ROAD 9/11/2019 FORM U - LOT RELEASE 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 or requirements. *****************************APPLICANT FILLS OUT THIS S€CT,56 ION*********************** APPLICANT or /Oe< /In /u PHONE LOCATION: Assessor's Map Number ^ PARCEL SUBDIVISION LOT (S) STREET ��-'�G�F� �� ST. NUMBER _Z � ***************OFFICIAL USE ONLY*********************************** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS � y TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED S C IN ECTOR-HEALTH DATE APPROVED { DATE REJECTED ` COMMENTS .- CJ /PUBLIC WORKS -SEWERMATER CONNECTIONS ! \ DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE FORM U - LOT RELEASE 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 or requirements. *************APPLICANT FILLS OUT THIS SECT ON APPLICANT %- 41 z oo// PHONE J LOCATION: Assessor's Map-Number PARCEL_ SUBDIVISION LOT (S) S STREET /i�'SCE A 1511- M ST. NUMBER 103 ****************OFF IC IAL USE ONLY*********w" **`**** RECOMMENDATIONS OF TOWN AGENTS: Lc waljl�� N E14VATION ADMINI TOR DATE APPROVED 3 1 DATE REJECTED COMMENTS22 C D t �� Lp✓ TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED L- SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS 0 ��t'Tic_ A. 0 _7De ia>>-c� PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE FORM U - LOT RELEASE FORM INS CT ONS: This form is used to verify that all necessary appr ' a /permits from Boards and Departments having jurisdiction have be obtained. This does not relieve the applicant and/or Lando er from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this sectio ***************** APPLICANT: l (-tit �w,, Phone �JG LOCATION: Assessor's Map Number I, (D 1 Parcel U U`�9 Subdivision v< <Cc 411 �=� Lot(s) `— Street St. Number 0 ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved 4/Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Hee�alth Date Rejected Date Approved Septic Spector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date