HomeMy WebLinkAboutLP storage tank permit - LP Gas Tank - 79 CAMPION ROAD 1/19/2016 Tam F,
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Application for Standard Permit
FP-006 .► Return completed application to: 41
(Rev.04/12)
Permit Number: EDIGSAFEUMBER
City or Town:&r'- h V e
Date: CA I1.6
In accorda ce withh the provisions of M.G.L.Chapter 148,as provided in Section application is hereby made
by 1�sJ C,�,(tVlrn0,(- (-,p)�?^ ?-�r"-�3 (0
/^ (Full Name of Person,Firm or Corporation) (Phone Number)
of vZ�`s C 11 S�C�(✓l Ave- 0/1 off-
(Address:Street or P.O.Box,City or Town,Zip Code)
for permission to(state clearly purpose for which
-permit is requested) S(ti,�v -e 12
Name of Competent Operator(if applicable) Vert.No. 6 _
Date_Issuedd -i9-/L By
(Signature of Applican)
Date of expiration Fee Amount Paid$
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L
FP-006
(Rev.04/12) PERMIT
City or Town: /'V" r I ' ` �
DIG SAFE NUMBER
Date: G`f 1 `l/l 6
�— / Start Date:
Permit Number(if applicable):
In accordanc with the provisions of M.G.L.Chapter 148,as provided in this permit is granted
to A'�t�S�CPVI rn�r
(Full Name of Person,Finn or Corporation)
for I`Z 00 LPA/0 (.7 h I b�n k-
Restrictions: 061 /� c>^tT �/IITiL t J 1,6f aC-
at G C�I✓n
(Street and#or Describe Location for Adequate Identification)
Fee Paid$ �� This permit wjtl expire on — -,r/ E
Signature of Official Granting Permit: ' Title
j This permit must be conspicuously posted upon the premises '