HomeMy WebLinkAboutMiscellaneous - 768 Waverley Road (2)MADE BY:
BOARD OF HEALTH
120 MAIN STREET
NORTH ANDOVER, MASS. 01845
COMPLAINT FORM
DATE-
ADDRESS:
ATE
TEL. 682-6400
ADDRESS:2/.
1 v TEL.
NATURE OF COMPLAINT
LOCATION: OCCUPANT
OWNER
REFERRED TO
ADDRESS
DO NOT WRITE BELOW THIS LINE
RESULT OF INVESTIGATION
RECOMMENDATIONS:
ACTION TAKEN:
DATE OF INVESTIGATION
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MADE BY : (�
BOARD OF HEALTH
120 MAIN STREET
NORTH ANDOVER, MASS. 01845
COMPLAINT FORM
DATE
TEL. 682-6400
ADDRESS: = /����d-�._1b TEL. (o
NATURE OF COMPLAINT
LOCATION: OCCUPANT
OWNER
ADDRESS
DO NOT WRITE BELOW TEIIS LINE
REFERRED TO DATE OF INVESTIGATION
RESULT OF INVESTIGATION
RECOMMENDATIONS:
ACTION TAKEN:
Of NORTH ,
4661
to 9
Town of North Andover
�y'• HEALTH DEPARTMENT
,SSACHUSE�
CHECK #: 110j�f�C)DATE: / Q�
Ivy
LOCATION:
H/O NAME:
CONTRACTOR NAME:
Tyye
of Permit or License: (Check 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
$
❑
TrashlSolid Waste Hauler
$
❑
Well Construction
$
SEPTIC Sustems:
❑
Septic - Soil Testing
$
❑
Septic - Design Approval
$
❑
Septic Disposal Works Construction (DWC)
$
❑
Septic Disposal Works Installers (DWI)
$
❑
Title 5 Inspector
$
❑
Title 5 Report
$
Al
Ilthey. (Indicate) $
Health Agent Initials
White - Applicant Yellow - Health Pink - Treasurer
-1
X11
f
Town Of North Andover
Department of Weights and Measures
1600 Osgood St. Suite 2-64 Blg 20
North Andover 01845
Phone (978)688-9540
(Cell) (508)783-6403
TO:
Petco
768 Waverly Rd.
North Andover 01845
RECEIVED
RL" � 0 2009
INVOICE
DATE: j7,' 1: —0J
AP EXPENSE
FOR:
Testing and Sealing of Weights and Measures Devices
Fees and adiustina charges authorized by Sectinn 5h. M (, i Chantar QR ac amanriari
Device
Legal Sealing
Fees
Adjusted
Sealed
AMOUNT
Scale more than 10lbs less than a 100lbs
$12.00
3
36.00
MOWED
JAI 1 1
10
TC
WN OF NORTH ANDOVER
HEALTH DEPARTMENT
TOTAL I $36.00
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. _ (\
M-17..01
Date
Inspector — Se e f Weights and Measures
01
7ct
Check Date: Ja .i07/2010 Check No. 0001105260
Invoice Number Invoice Date Voucher ID Gross Amount Discount Available Paid Amount
2775-WM1.10 Dec/31/2009 02457575 36.00 0.00 36.00
JAN 11 2010
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
Vendor Number
Name Total Discounts
89097
TOWN OF NORTH ANDOVER S0,00
Check Number Date
Amount Dicallut'R laken lotni Paid Amount
0001105260 Jan/07/2010
—Iota,
$36.00 $0.00 $36.00