HomeMy WebLinkAboutMiscellaneous - 149 CAMPBELL ROAD 4/30/2018 _i
149 CAMPBELL ROAD L _
2101106Op00.0 ` z)EW
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�OL 3 BOARD OF HEALTH
27 CHARLES STREET
NORTH ANDOVER,M g0 40
TELEPHONE# (978) 68
APPLICATION FOR AB�DO VMENT
OF SUBSURFACE DISPOSAL
10 CMR 11.314
Pursuant to Section Code, Title V
of the State Environmental �^ �^
Phone qf LA
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Name
Address
or work: 6_-08Z
Contractor hiredfor 7&— 6e
phone
Namet?1�
Address aas
Date for scheduled abandonment abandoned according to
system at the above address has been aba ,T G-1
The septic ,� r 1
Title V specifications.
Signature of Contractor
tank abandonment (check
one). ( ) removal ( ) sandfill
Method of Septic
crush ( ) other n 1�
Name of Offal Hauler $ealth.
This form must be returned to the North Andover Board of
THE SPACE BELOW FOR HEALTH
IN PLEASE DO NOT WRI SENTATIVE'S USE ONLY.
CPRE
{
Date
Inspecting A en
1696 % l .� � Aom,?
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APPLICATION FOR SEWER SERVICE CONNECTION
North Andover, Mass.
Application by the undersigned is hereby made to connect with the town sewer main in vel Street,
subject to the rules and regulations of the Division of Public Works.
The premises are known as No. dl
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Street—
or subdivision lot no. {'
sc-i W.--,dl--e
Owner Address
it
Contractor Ad ress
pli ant's Sign re
Co1�v50cova-F/od
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PERMIT TO CONNECT WITH SEWER MAIN
a
The Division of Public Works hereby grants permission to !/
to make a connection with the sewer main at P ( Street
subject to the rules and regulations of the Division of Public Works..
Division of Public Wo ks
By—
Inspected
yInspected by l
DateI.
See back for rules and regulations '
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