Sprague E 15606 Restaurant Addition
DEPAATIIAENTAL REVIEW
Ap~~ Cond. Hold
Approval
Emrlronmanfal Health Appllcatlon /
2flw. Collspe ~Room 200
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Planning/Zoning
N. T21 Jefferson 7 ,
Engineers . MA
811 Jelterson ,
uturuss
❑ N. 811 Jeiferaon
Pbn Revisw/Firo Prevenfton
N 811 Jetferson
ME
Othsr (SEPA1Crltleel Meterisi/eta.) y
❑ 0 a Fast Tradc/Speclal Inepactlon Intotmstfon
Pe'oJect Aepresentatlve Phone ~
Address
I Cehlly that 1 heve examtned thta appitcation and, etate tAat the lnformatlon contalned In ft and auDmitted
py me or my agent to oomplle said applicatlon te true and correct
SIAr~atu►e /JPo Date J-
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