HomeMy WebLinkAboutLP storage tank permit - LP Gas Tank - 790 DALE STREET 11/20/2015 V
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Application for Standard Permit ;r
FP-006 Return completed application to:
(Rev.1.1.2015)
Permit Number: DIG SAFE NUMBER
City or Town: ( +
�` s �` Start Date:
Date:
In accordance with the provisions o�f,M..G�.L. Chapter 148,as provided in Section / (, aappplication is hereby made
""by �n1�C{ S � �=�tom"\'
r-� (Full me of P�son,Firm or Corpoorat-n) (Phone Num(b`err))
(Address:Street or P.O.Box, ity or Town,Zip Code)
for permission to(state clearly purpose for which permit is requested)
r 1c
Name of Competent Operator(if applicable Q e
M V�Rert. No.
Date Issued-rejected By
(Signature of Applicant)
Date of expiration Fee Amount Paid$
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FP-006
(Rev. 1.1.2015) PERMIT
City or Town: �V`�-' t (�'� -U 1�tJ1"! DIG SAFE NUMBER
Date: 3�—
Start Date:
Permit Number(if applicable):
In accordance with the provisions of M.G.L. Chapter 148,as provided in ,-�-_ th' `permit(is grant
to rVl � {TfA
(Full Na a of Person,Firm or Corporation) f
for _ ` - '
Restrictions: �54 ____
ks
(Street and or Describe Location for Adequate Identification)
Fee Paid$,� -- This permit will expire on
Signature of Official Granting Permit: itle
This permit must be conspicuously posted upon the premises
Application for Standard Permit
FP-006(Rev. 1.1.2015) F* Return completed application to: 41Permit Number: DIG SAFE NUMBER
City or Town: ��L42` N(Vkn( k'c'iY—
Date: �\— ` Start Date:
In accordance with the provisions of M.G.L.Chapter 148,as provided in Section application is hereby made
by ��y�
-`-(Full�he of son,Firm or Corporation) C t (Phone m Mft
of
(Address:Street or P.O.Box, ity or Town,Zip Code)f
for permission to(state clearly purpose for which permit is requested)
Name of Competent Operator(if applicable �5 �Ztert.No.
Date Issued-re' t!- " / By �
f (Signature of Applicant)
Date of expiration Fee Amount Paid$ T
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FP-006
(Rev. 1.1.2015) PERMIT
City or Town: -(��� �� DIG SAFE NUMBER
Date: �\ ����
Start Date:
Permit Number(if applicable):
In accordance with the provisions of M.G.L. Chapter 148,as provided in this"permi is grant d }q ,��
(F�II Na a of Person,Firm or Corpor tion)
for' !(1 _.— (+ -
Restrictions:at
(Street and A or Describe Location for Adequate Identification)
Fee Paid$_�_. This permit will expire on
Signature of Official Granting Permit: Title arc G�
00 This permit must be conspicuously posted upon the premises