HomeMy WebLinkAboutMiscellaneous - 120 LACONIA CIRCLE 4/30/2018 (25) TOWN OF NORTH ANDOVER Permit Number
NORTH ANDOVER,MASSACHUSETTS 01845
all Date Issued
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Expiration Date -
Jackie's Law — Permit Application
Pursuant to G.L. c. 82A §1 and 520 CMR 7.00 et seq.(as amended)
THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION
Name of Applicant i `J 5504 le Phone Cell = _
Street '96
A. A&I-
17fr,,O--
MA ZIP
611 4
Name of Excavator(If diffe from applicaniQ Phone Cell
WAA/Udress
8,0 /' .
city/Town MA ZIP
N of Owns s)of Property Phone Ten
Address
Cwff'own MA ZIP
Other Contact I Permit Ree Received 7NJ Y
Description,location and purpose of proposed trench:
Please describe the exact location of the proposed trench and its purpose(include a description of what is(or is intended)to
be laid in proposed trench(eg,pipeslcable lines etc.)Please use reverse side if additional space is needed.
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Insurance Certificate