HomeMy WebLinkAboutLP storage permit - LP Gas Tank - 247B FARNUM STREET 11/17/2015 Application for Standard Permit
FP-006 y Return completed application to:
(Rev. 1.1:2015)
Permit Number: {� DIG SAFE NUMBER
City or Town:
Date: ��— Start Date:
In accordance with the provisions of M.G.L. Chapter 148, as provided in Section application is hereby made
(Full NaMp of Pers ,Firm or Corporation) (Phone Number)
of l ( t �?
(Address:Street or P.O.Box, ity or Town,Zip Code)
for permission to(state clearly purpose for which permit is requested)
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Name of Competent Operator(if applicable) No.
Date Issued-rejected By C-"
(Signature of Applicant) r y )
Date of expiration Fee Amount Paid$
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FP-006
(Rev. 1.1.2015) PERMIT
City or Town: DIG SAFE NUMBER
Date: �'"`� '"'�a�
Start Date:
Permit Number(if applicable):
In accordance with the provisions of M.G.L. Chapter 148,as provided in this ermit is ranted } _
to
(Full Name of Person,Firm or Corporation)
for
Restrictions:
at °`l
(Street and#or Describe Location for Adequate Identification)
Fee Paid$ r �- This permit will expire on
Signature of Official Granting Permit: rs F P Title �n(
0 This permit must be conspicuously posted upon the premises
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