HomeMy WebLinkAboutDumpster Application & Permit - Permits - 116 HICKORY HILL ROAD 1/11/2017 The COMMOn'�'�eafth of Massachusetts
iR�= DOPUtMOnt of Fare S(SpV Cea
~3° Office ®f the State Fare mareha�
P•0.Box 1025 State Road,Stow,MA 01775
a� .
APPLICATION FOR PERMIT
Date:
Permit No —
City or Town)
(IfApplicable) Dig safe 1Vtmaber
In accordance with the provisions of M.G.L, Chapter ._ID as
provided in S coon _5 2 7 CMR 3 4 application is hereby made Start Date
by
(Full name of on, irnl or cogn or p)
hate clearly Address
urpose for
tract orP.O_Box ity or Town)
itequested Far ermissionto Locate dumpster for construction/renovation/demolition ';`sregnested p of strudt re
Comments: dumpster must be 25 , from structure or covered when not in use
at
(Give location street and no ox describe in such manner as to provied adequate identification,of location)
Name of competent operator Cart.No.
(ifApplicable)
Date Issued-rejected
By
s
(Signature o/Appant)
Date o£expiratson Fee$ Paid Due
--------..-------------_-_
The Commonwealth of Massachusetts
' N
a ear tent Of Firs Services
Office Of the State Fire ,Marshal
P.O.BOX 1025 State Road,Stow,MA 01775
Permit No Date:
(City of Town) (If Applicable) D=Number
In accordance with the provisions of M.G.L, Chapter l Oas provided in section 5 2 7 CMR 34
This Permit is granted to: ��,6� a I<- rtData
Full name of person,.Firm or rporation
Pemussionto locate dumpster for construction/renovation/demolition of structure
Camments: dumpster be 25 ' from structure or covered with tarp or plywood
Restrictions: at end o f workday
at 14 ���' .�- .1/�
(Give location by stree d no,,or describe in such manner astoprqvlud adequate identification of location)
Fee Paid S
1
This Permit will expire o- /�`t
f (Signature o£o cal granting permit) Off Ell granting permit (Title)
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