HomeMy WebLinkAboutLP storage tank permit - LP Gas Tank - 89 BLUEBERRY HILL LANE 3/25/2015 Application for Standard Permit
FP-006 0 Return completed application to:
(Rev. 1.1.2015)
Permit Number: (� DIG SAFE NUMBER
City or Town:
Start Date:
Date: i. _— �'�
In accordance with the provisions of M.G.L. Chapter 148,as provided in Section application is hereby made
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(Fu ame of Verson,Firm or Corporation) (Phone Number)
(Address:Street or .O.Box,City or Tokn,Zip Code)
for permission to(state clearly purpose for which permit is requested)
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Name of Competent Operator(if applicable) "s �2�( ert. No.
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Date Issued-ejestec `�— /3 By � t --" —.
J_ (Signature of Applicant)
Date of expiration �_T — Fee U Amount Paid$
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FP-006
(Rev. 1.1.2015) PERMIT
City or Town: V\c C)L ��1 ' DIG SAFE NUMBER
Date: S of
Start Date:
Permit Number(if applicable):
In accordance with the provisions of M.G.L. Chapter 148,as provided in th' ,permits s granted
(Full Name of Person,Firm or C Kporation) „
Restrictions:at
` � f
(Street and#or Describe Location for Adequate Identification)
Fee Paid$ Cam' This permit will expire on £—
Signature of Official Granting Permit: Title /i`lt
111111110. This permit must be conspicuously posted upon the premises #011111'
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Application for Standard Permit
FP-006 0 Return completed application to:
(Rev. 1.1.2015)
Permit Number: DIG SAFE NUMBER
City or Town: G�t
� — Start Date:
Date: _ � 1.`�
In accordance with the provisions of M.G.L. Chapter 148,as provided in Section application is hereby made
(Fu ame of Verson,Firm or Corporation) (Phone Number)
(Address:Street or .O.Box,City or Tokn,Zip Code)
for permission to(state clearly purpose for which permit is requested)
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Name of Competent Operator(if applicable)� 0_� N �;� MLAACert. No. 'll, \.L4. 1
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: DIG SAFE NUMBER
Date: �;— `
Start Date:
Permit Number(if applicable):
In accordance with the provisions of M.G.L. Chapter 148, as provided in _th's,permit,is grante„
to
(Full Name of Person,Firm or C rporation)
for _Jam_ ,
Restrictions: Y� 5�,� 71 � s t Vl Ace
(Street and d—#orescribe Location for Adequate Identification)
Fee Paid$ ->�% H This permit will expire on
Signature of Official Granting Permit:
Mok This permit must be conspicuously posted upon the premises
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