HomeMy WebLinkAboutHealth Permit # 11/9/1999 1
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APPLICATION FOR DISPOSAL WORDS CONSTRUCTION PERMIT
DATE: w CURRE'NT INSTALLER'S LICENSE#
LOCATION:
LICENSED INSTALLER; E7a
SIGNATURE: ALAIILP 4 TELEPHONE# ,
CHECK ONE: ��7 7 ,15
REPAIR: NEW CONSTRUCTION:
IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT,
Administrative Use Only
$75,00 Fee Attached? Yes - No
Foundation As-Built? Yes No
Floor Plans? Yes No
Approval �� ., %' Date:_ ',�
..-__ k--.NSF,.w.."..1^r•. ;,-sue* ,,..,.-... .�....,.,............
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TOWN OF NOf-,TH ANDOVER SEWAGE DISPOISAL SYS�E1�[
INSTALLATION CERTIFICATION
The undersismed here°_,v certify that the Se'.-vale Disposal System i ! co::stt~.ictcd;
(/,) re^aired: . . -
v
located at 2 2
was installed in con c mance with•the North Andover Board of Heaith aoprovec' plan.
System Desi,Yn Pec -it r dated with an approved desip
tlow or ) aflcas per day The mate rals use% were in conformarcti �.vit`1 those
speciiied oh the app'roved' plan; the system was installed in accorda-xe ,,,7th the provisions
of 310 C:v1T 15.000, Title 5 and local regulations, and the anal ryradima agrees
substantially with the approved plan. ,•ail worn is accurateiv represented ;)r 'the As-built
whkh has been submitted to the Board c 'Health.
y
Bed inspection 'date:
Engineer ReprLs.zr::ative
Final inspect:on care
Encir,e°r Representat:ve
tnsta!ler: � i � c.m a Date
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DesiLTn En(2ineer:
Datz
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