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('onus nwealtlt of Massachusetts
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Massad sells
System Putup ng Record
Syslem Owliel System Location
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Dale of Pumping: (luaiitily Pumped: 1 0 gallons
Cesspool:ol: No Yes Septic Tank: No Yes
Syslem lImpped by: is re4ort Fifam#iMeJ License #
Contennts lransferrred to : Neater L awlellce 80111 rY pistrIS t
Dale: _--- Inspector:
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Town of North Andover
Building Department
27 Charles Street
North Andover,Massachusetts 01845
(978) 688-9545 Fax (978) 688-9542 �` .� -V
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APPLICATION FOR CERTIFICATE OF OCCUPANCY!INSPECTION
ADDRESS /j�7 k'ea 5f. NO2 I�Ldwe4 , � e1016_
LOT NUMBER (iii/,7 "3 SUBDIVISION 1-act'1rtlt' 79 M
DATE REQUEST FILED
DATE READY FOR INSPECTION U�d/Q V
TEN (10)DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED
ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME
FRAME. A RE-INSPECTION FEE OF TWENTY-FIVE($25.)DOLLARS WILL BE
CHARGED IF THE S C OES T . ET ALL APPLICABLE CODES.
SIGNATURE
OFFICIAL USE ONLY
ROUTING
D.P.W. —WATER METER DATE (�
D.P_W_ MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED
TO T INSPECTION QUEST DATE.
SIGNATURE/DPW AU RIZATION
RECEE
JUL 2 2004
BUILDING DP77