HomeMy WebLinkAboutRadio Box installation permit - Permits - 1/10/2012 Ea
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APPLICATION FOR PERMIT
City or Town DIG SAFE NUMBER
Date /— J •' [8tart Date:
In accordance with the provisions of M.G.L. Chapter 148, as provided in Section application is hereby made
by V t 1,jCt2,_1T
(Full name of person,Firm or Corporation)
Address c � 'X>44 C-
(Street or P.O.Box)(City or Town)
For permission to (state clearly purpose for which permit is requested)
jZ� t t`►S�u.� �r'�-t�iCG ��' ,�' i �tx:� C�CC;yUc�G
Name of competent operator(If Applicable) Cert. No.
Date Issued-rejected By 14cel &
(Signature of Applicant)
Date of expiration Fee $ Paid Due
3(rev.3/00)
PERMIT
City or Town//;�Cf dj/c,/ DIG SAFE NUMBER
Date_
Start Date:
Permit Number(if applicable)
In accordance with the provis
ions of M�G.L. Chapter 148, as provided in this permit is granted
to Y r'tl (Fuji name of person,Firm or corporation)
for ✓� // % o-� c�� �' c� �° /�`r
Restrictions:
at o' U S� c� c✓ j
(Give location by street and no.,or describe in such manner as to provide adequate identification��of location) .
"—Z� -- , This Permit will expire on tea (io/bY?"
Fee Paid $ S
Signature of•Official Granting Permit '"� . :` Titles it f
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