HomeMy WebLinkAboutHealth Permit # 4/20/1999 Town of North Andover, Massachusetts Form No.3
of NORTH 1 BOARD OF HEALTH
o m � 19 l
A
DISPOSAL WORKS CONSTRUCTION PERMIT
SSACNUS�
Applicant ��'
NAME ADDRESS >> / TELEPHONE
Site Location_
Permission is hereby granted to Construct-) or Repair ( ) an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No. ID/ /
CHAIRMAN, BOARD OF HEALTH
Fee D.W.C. No. /09/
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE: %` �?' CURRENT INSTALLER'S LICENSE#
LOCATION:
LICENSED INSTALLER; ' "'... ~'..
�° �°` . . �w. _...-
SIGNATURE: TELEPHONE#,, � { +
CHECK ONE:
REPAIR: 7,W CONSTRUCTION:
IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT.
Admistrative Use Only
CJ
$75.00 Fee Attached? Yeses No
Foundation As-Built? �'e""""Yis Na
Floor Plans? Yes ' w .. . No
Approval "� Date: wm