HomeMy WebLinkAboutLP aboveground storage tank permit - LP Gas Tank - 173 COACHMAN LANE 8/14/2015 FP6(rev.3/00)
APPLICATION FOR PERMIT
DIG SAFE NUMBER
City or Town - - d'!�PY
Dates CStail Date:
In accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10A application.is hereby made
by ✓514
l/ (Full name of person,Firm or Corporation)
Address� ._Lr��f t74'1aY1y� i 4c -n
(Street or P.O.Box)(City or Town)
For permission to (state clearly purpose for which permit is requested) y L ,s // / Z9 4 c/n
LAI-
Name of competent operator(If Applicable) z �, Cert. No. 10,�2,;j_
Date Issued-r-* --9/�— J By
(Signature of Applicant)
Date of expiration Fee 2 �:: - $ Paid Due
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FP6(rev.3/00) �. 7025, C� e e&w, G&Q.Q(0 775
PERMIT
City or Town A� EStart
DIG SAFE NUMBER
Date
Permit Number(if applicable)
In accordance with the provisions of M.G.L.Chapter 148, as provided in 10A this permit is granted
to > >' �`y� r � c�/ r.�).�� L t, o/ to
(Full namdof person,Firm or Corporation)
for
Restrictions: /1V /bc&e,7--oa J-,,-i- on7-,-I-
at -2
(Give tocation by street and no.,or describe in such manner as to provide adequate identification of Location)
Fee Paid$ Thiser it will expire on
Signature of Official Granting Permit Title
No This permit must be conspicuously posted upon the premises
Sitewalk Checklist for Sketch
Sketch Checklist: o Tank to House o Leech Bed
o All Windows that apply o Second Stage Regulator o Driveway
o All Doors that apply to Windows o Temporary Tank Location
o All Sources of Ignition o Second Stage Regulator o Only 1 temporary tank
o Second Stage Regulator to Doors needed/allowed
o All Measurements o Second Stage Regulator o 2 temporary tanks
o Tank to Windows to Sources of Ignition needed
o Tank to Doors o Second Stage Regulator
o Tank to all Property Lines to Tank(including
o Tank to Sources of temporary tanks where
Ignition applicable)
Comm is (notes from technician to office)___.__
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n � T
Office Notes/ Correspondence (customers/technicians/other customers):
Sitewalk Drawing:
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