HomeMy WebLinkAboutDumpster Application & Permit - Permits - 3/28/2017 � 4
The Comm on,�fvea�th of
ofrur-e of the Stafe Fore ars�a�
Pn
r P-O.Box 1025 State Road,Stoat,MA 01775
APPUCAT�ON FOR PERMIT
Date:
Permit No
(City or Town)
(If Applicable) Dig,Safe Number
In accordance with the provisions of M.G.L. Chapter 00 as
provided in Section 527 CMR 34
application is hereby mach Start Date
by _ ���.� <<,-Pnz111 A
(Full name ofperson,Firm or Corporation)
hate clearly Address i�'Y J 4
vhich p for (Street or P_O_Box City or Town)
srequested For permission to Locate dumpster for construction/renovation/demolition
srequested p of structure
Comments; dumpster must be 25 ° from structure or covered when not in use
at l
(Give location by street and no,,or describe in such manner as to provied adequate identification of location)
Name of competent operator Cent.Na.
(If Applicable)
Date Issued-rejected
By Dwt
(Signature of Applicant)
Date of expiration j — Fee Paid
---- -- - _ _ ------—------------------—-----------
— Due
`- —---------- ----------- -~--------_ _....--------------.--
The Commonwealth of Massachusetts
Department of Firs ServicesXQk
a` OffiCe Of the State Firs Marshal
P.O.Box 1025 State Road,Stow,MA 01775
Permit N� PERM.IT Date;
(City of Town) (If Applicable) EStaztDat�
g Safe 71NIumler
7
In accordance with the provisions of M.G.L. Chapter l 0as provided in section 5 2 7 CMR 3 4
This Permit is granted to: /
� , �/2-6�-ai
Full name of person,Firm or Corporation
Permission to locate dumpster for construction/renovation/demolition of structure
Comments: dumpster be 25 ` from structure or covered with tarp or plywood
Restrictions; at end Of workday
------------------------
at �.��_
(Give location by street and no.,or describe to such manner as to provied adequate ldeatiilcation of location)
Fee Paid S
rb
This Permit will expire (Signature of o tiu rmit g Pe ) Of�cat g Permit (Title)
T141-q PPr?UIT 1 l_Q`r RP (`nm-R01r-n ini l.q1 V Pf)-Q Pn l lPf) P;z PPPm1C1=