HomeMy WebLinkAboutLP tank storage - LP Gas Tank - 115 CAMPION ROAD 11/16/2015 �,`,��;��,/
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Application for Standard Permit
FP-006 1+ Return completed application to:
(Rev.04/12)
Permit Number: DIG SAFE NUMBER
City or Town:
Y Start Date:
Date: I 1 1�
In accordance with
the provisions of M.G.L.Chapter 148,as provided in Section �i application is hereby made
C� f�� (Full Name of Person,Firm or Corporation) r (Phone Number)
of `� l.Gls�<�r✓l ��1� C�1�1��� ox
(Address:Street or P.O.Box,City or Town,Zip Code) f
for permission to(state clearly purpose for which permit is requested) 1 ' ( C1 (
Name of Competent Operator(if applicable) ert.No.
Date„Issued-relm-ted—/ Lam/--/ By
(Signature of Applican) �l
Date of expiration, r<��ni/� Fee Amount Paid
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FP-006
(Rev.04/12) PERMIT
City or Town: l�J / c�, f� DIG SAFE NUMBER
Date: l
Start Date:
Permit Number(if applicable):
In accordant with the provisions of M.G.L.Chapter 148,as provided in this permit is granted
to ��5��CPd�IY1Qr
(Full Name of Person,Finn or Corporation)
for cr `—
Restrictions: /
at b C �.� f 6--, J
V (Street and#or Describe Location for Adequate Identification)
Fee Paid$ This permit will expire on 1� �✓��i��
Signature of Official Granting Permit: Title
t This permit must be conspicuously posted upon the premises r^"''