HomeMy WebLinkAboutMiscellaneous - 136 MAIN STREET 4/30/2018 (2) i
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Town of North Andover
` '•�;, HEALTH DEPARTMENT
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CHECK#: �� DATE:
LOCATION:
H/O NAME: o
CONTRACTO AME:ffa
Tyye of Permit or License: (Chec box)
❑ Animal $
❑ Body Art Establishment $
❑ Body Art Practitioner $
❑ Dumpster $
❑ Food Service-Type: $
❑ Funeral Directors $
❑ Massage Establishment $
❑ Massage Practice $
❑ Offal(Septic)Hauler $
❑ Recreational Camp $
❑ Sun tanning $
❑ Swimming Pool $
❑ Tobacco $
❑ Trash/Solid Waste Hauler $
❑ Well Construction $
SEPTIC Systems:
❑ Septic-Soil Testing $
❑ Septic-Design Approval $
❑ Septic Disposal Works Construction(DWC) $
❑ Septic Disposal Works Installers(DWI) $
❑ Title 5 Inspector $
❑ Title 5 Report $
C��Cfther. (Indicate) $� �
Health Agent Initials
White-Applicant Yellow-Health Pink-Treasurer
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Town Of North Andover
Department of Weights and Measures
1600 Osgood St. Big 20 Suite 2-36
North Andover 01845
Phone (508)783-6403
DATE: 12/4/10
TO: FOR:
Main St Hardware Testing and Sealing of Weights and Measures Devices
136 Main St.
North Andover 01845
Fees and adjusting charges authorized by Section 56, M.G.L. Chapter 98 as amended.
Device Legal Sealing Adjusted Sealed AMOUNT
Fees
Scale more than 10lbs less than a 100lbs $12.00 1 $12.00
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DECI 17 2010
TOWN OF NORTH ANDOVER
HEALTII DEPARTMENT
TOTAL $12.00
This is to certify that I have this day tested, adjusted, sealed or condemned the above described device in compliance with the
M.G.L., Chapter 98 as most recently amended.
Inspector—Sealer of Weights and Measures
Date