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HomeMy WebLinkAboutPass - Title 5 - Receipt - 332 RALEIGH TAVERN LANE 5/31/2022 O`NOR TN,h / 4 'I !L 0 Town of North Andover HEALTH DEPARTMENT ,SSgCHU`.at CHECK#: DATE: ay.3/.-2aa2 F LOCATION: .3 3 2- A eoA H/O NAME: t CONTRACTOR NAME: /60-fe.,S 0/,) Type 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 $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DW0 $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector `� $ Title 5 Report ❑ Other. (Indicate) $ Hea th Agent Initials E White-Applicant Yellow-Health Pink-Treasurer