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Board of Appeals - Board of Health - planning.Board _ Conservation Commission -
Building Departrnen�t -�
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3� ° ' ° BOARD OF HEALTH ��
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t " ' 120 MAIN STREET
'° �°��.:,, '� y TEL: 682-6483
NUNORTH ANDOVER, MASS. 01845 Ext. 32 or 33
SSS^CSE�
APPLICATION FOR DUMPSTER PERMIT
PURSUANT TO SECTION 31A AND 31B OF CHAPTER 111
OF THE GENERAL LAWS, AND RULES AND
REGULATIONS OF THE a
s
NORTH ANDOVER BOARD OF HEALTH
DATE
TO THE BOARD OF HEALTH: � .
Application is hereby made for a permit to maintain a dumpster on
property located at �� -
in accordance with the Rules and Regulations of the Board of
Health
Check use:
( ) , Residential use ( of Commercial use
( ) 30 day temporary ( ) Annual
Name of applicant:
Owner of property:
Telephone number:
On the bottom half of this form, please sketch an outline of
property, showing the proposed location of the dumpster. Give
distance from dumpster to other buildings and lot lines or
boundaries. Use back side if additional space is needed.
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Please return this application with a ee of $10. 00 ($5. 00 for
temporary permit) to: Board of Health, 120 Main St. , No. Andover,
MA 01845.
t 4
NUMBER
FEE
THE COMMONWEALTH OF MASSACHUSETTS
TOWN of NORTH ANDOVER
Thisis to Certify that .............VPS...................................................................................................
NAME
49 CHarles Street, North Andover, MA
-----------•-----------------------------------------------------------------•-------.....-----•-------------•------------------------•----••---..._---•--
ADDRESS
IS HEREBY GRANTED A PERMIT
For .......................................................aitain One (1) Dumpster
--------------------------------• ----••....--•---•---
-----•----•------------•-------------•---••-------•-----........------•-----•--------••----•--...-------------------•-----------------------••-----•----------..
-------------------------------------------------•----•-•-....•---•-....--............_••---•---.••--....--••-••----------••-----------•---------•-•-----------------
------------------------------------•----------•--------------------•------•-----••-----------•------------••-•-------•-..............--------••-............
This permit is granted in conformity with the Statutes and ordinances relating thereto, and
expires........Dacemhe-r-...31......19.9.2..........unless sooner,ispendedis revoked.
... .... ........
JarivarY l5, 19--9.2 yi 2..Z c?,...
...... .. .... a-
-----------------------
...............................
FORM 451 HOBBS & WARREN, INC.