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FP6(rev.3/00)
APPLICATION FOR PERMIT
City or Town
North Andover DIG SA E NUMBER
DateFStart :
In accordance with the provisions of M.G.L. Chapter 148, as provided in Section application is hereby made
i
(Full name of person,Firm or Corporation)
Address 2 �J �J<<, �07-c c tc
(Street or P_O-Box)(City or Town)
For permission to (state clearly purpose for which permit is requested) T" l° y
71
f/ S 6 �t
Name.of competent operator(if Applicable) ��` J l c Cert. No.
Date Issued-rejected 1-/D -/ / By i
(Signatur o/ pplicant)
Date of expiration Fee 5-7- $ Paid Z Due
�� - �t a 600
FP6(rev.3100) ✓ /CJOZ �02�J,. �i%t GCLLLf ��dLl�� ����2LX� �7/ ��l_
PERMIT
City or Town North- Andover DIG SA ENUMBER
Date
[Start Date:
Permit Number (if applicable)
In accordance with the provisions of M.G.L. Chapter 148, as provided in this permit is granted
to
(Full
name of person,, irm or Corporation)
for`r'�.�c�iE_ (l�//��. f.L zo/s l .;,p � �ti� oo.� ��a.� ;� tii�� K'2Cr���
Restrictions:
at L ai .Pi1/�i`/'j` C�✓ �/��d� ����L�'fi� 2
(Give location by street and no.,or describe in such manner as to provide adequate identification of location)
Fee Paid $ _ This Permit will expire on 1--" Z � ��✓�Gr,
Signature of,Official Granting Permit Title _/Midi-
This permit must conspicuously posted upon the premises