HomeMy WebLinkAboutHealth Permit # 2/24/2006 Commonwealth of Massachusetts Map-Block-Lot
107.C-0046-
Board of Health
~ Permit No
North Andover BHP-2006-0052
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g' •» •'"'R FEE
S,kc JS F.I. — $250.00
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Disposal Works Construction Permit
Permission is hereby granted Mike Reilly
to(Repair)an Individual Sewage Disposal System.
at No 89 MARIAN DRIVE
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as shown on the application for Disposal Works Construction Permit No. BHP-2006 7005 Dated February 24,2006 j
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Issued O-- Feb-24-2006 _.v Board o th
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' Construction� I — TOWN TODAY'S DATE -Full OJN $,250 Qo. cull
- ` "� � . 0145 �.
' 125-:00'Co '"i"ponent
Important: ,q 3lication is hereby made for a s�ermlt to. ~�
When filling out
forms on the ❑ Cot struct a new on-site sewage disposal systems
computer,use
only the tab key epair or replace an existing on-site sewage disposal system*
to move your ❑ Repair or replace an existing system component
cursor-do not
key the return A. Facility Information
Y
p Address or Lot# — - ----
�xwn City/Town
2.e*TYPE OF §EPTIC_SYST'EM*:
❑ Pump ravity (choose one)
***If pump system, attach copy of electrical permit to application***
❑ Co ntional System (pipe and stone system)
D,llkltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system.
❑ Pressure Distribution S.A.S. (No D-Box) (Attach Draft Maintenance Agreement)
❑ Pressure Dosed (D-Box Present)S.A.S.
2. Owner Information
Name
Address(if diffe ent from above) �
City/Town State Zip Code
p z Tele home Number
3. Installer Information
on
a
Name Name of Comp ny
z,
Address
City/Town - - -- State Zip Code —
Telephone Number(Cell phone#if possible please)
4. esicln�r Information
— Name of Company
w �e
Name r"
Address —
City/Town State gym- --- Zip Code --
Telephone Number(Be st#to�Reach)
Application for Disposal System Construction Permit.Page 1 of 2
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