HomeMy WebLinkAboutHealth Permit # 3/12/2002 Town of North Andover, Massachusetts F°"" ^'° a
of %ORTH1 BOARD OF HEALTH
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'°•,.,o:��'� DISPOSAL WORKS CONSTRUCTION PERMIT
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Applicant
NAMEy 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.
CHAIRMAN,BOARD OF HEALTH
Fee. � D.W.C. No.
BOARD CSI' ,ALT H
NORTH ANDOVER, MA 01845
978-68$-9540
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE: CURRENT INSTALLER'S LICENSE# (", ,;)
LOCATION:
LICENSED INSTALLER: ,
SIGNATURE: :,, ��,m ti , TELEPHONE#
4
CHECK ONE:
REPAIR: i NEW CONSTRUCTION:
IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT.
Administrative Use Only
$160.00 Fee Attached? Yes l, ''s No
Foundation As-Built? Yes No
Floor Plans? Yes No
A roval
1'p Date: