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QORM U - LOT RELEASE FOFCIVI
' 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 SECTION***********************
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LOCATION: Assessor's Map Number,
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******************************OFFICIAL USE
AGENTS:
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PARCEL V
LOT (S) 3
ST. NUMBER_La§—
CONSEKWTIOR ADMINISfRATOR DATE APPROVED
DATE REJECTED
COMMENT�_
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TOWN PLANNER DATE APPROVED 2�2 �5_
COMMENTS DATE REJECJ-_Q>-,�����
FOOD INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
SEPTIC INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
COMMENTS
PUBLIC WORKS - SEWERIWATER CONNECTIONS
DRIV�WAY PERMIT
AJFIRE DEPARTMENT
RECEIVED BY BUILDING
Revised 9X97 J*M
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DATE