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HomeMy WebLinkAboutMiscellaneous - 41 CHICKERING ROAD 4/30/2018 (2) i ® m z v I 1674 APPLICATION FOR SEWER SERVICE CONNECTION 2©D North Andover, Mass. 19—�- Application by the undersigned is hereby made to connect with the town sewer main in c Sueew subject to the rules and regulations of the Division of Public Works. e The premises are known as No. r4;e, Street or subdi ' ion lot no. Owner Address Contractor Address Applicant's Signature PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to to make a connection with the sewer main at Street subject to the rules and regulations of the Division of Public Works.. Division of Public Works By Inspected by Date See back for rules and regulations Insurance Adjustment Service, Inc. 139 Billerica Road, Unit A-1 Chelmsford, MA 01824 (978) 256-3334 Fax (978) 256-3354 UNDER MASSACHUSETTS GENERAL LAWS CHAPTER 139 SECTION 313 December 26, 2008 TO: Board of Health/Building Inspector RE: Insured: Diane Conserva Property Address: 41 Chickering Rd No Andover MA 01845 JAN 0 5 2009 TOWN OF NORTH ANDOVER Date of Loss: 12/12/2008 HEALTH DEPARTMENT Policy Number: HMA2047715 Type of Loss: Power loss caused sump pump to stop working,basement flooded. File or Claim Number: 52102 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed$1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6,to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 38 is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, locations, policy number,date of loss and claim or file number. Thank you for your cooperation. Very Truly yours, Tim Martino Adjuster Ext. 135