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THE COMMONWEALTH OF MASSACHUSETTS
TOWN OFNORTHANDOVER
BOARD OFHEALTH
Date: December 18, 1997
Permit# : 149-8D
This is to certy that: CHARLES T MA TSES REALTY, 29 Charles St., North Andover,
MA 01845
IS HEREBY GRANTED A DUMPSTER PERMIT
This permit is granted in conformity with statutes and ordinances relating thereto, and
expires DECEMBER 31, 1998 unless sooner suspended or revoked
Gayton Osgood, Chairman
Francis P. MacMillan, M.D., Member
John S. Rizza, D.M.D., Member
TOWN OF NORTH ANDOVER
BOARD OF HEALTH
30 SCHOOL STREET
NORTH ANDOVER, MASSACHUSETTS 01845
TELEPHONE4 (978) 688-9540
APPLICATION FOR DUMPSTER PERMIT
PURSUANT TO SECTION 31A AND 313 OF CHAPTER III
OF THE GENERAL LAWS, AND RULES AND
REGULATIONS OF THE
NORTH ANDOVER BOARD OF HEALTH
DATE:—
Application is hereby made for a permit to maintain a dumpster(s)
an property located at -2 1�- C�OLA,(ad 5-t7t�
in accordance with ruies and regulations oLF �theBoard of
Health.
Number of Dumpsters: I
Check use:
Residential use
Commercial use
30 day temporary
Annual
Name of applicant:
Owner of property:
Telephone#: 2 W -
(0 ?
Dumpster Company:
Telephone#:
Pick -Up Sch
-721j) C_,_
7iVA4 44
Trash Contractor:-
-
/Lb��.
Frequency of Pick7:Up-:
—/
On the bottom half
of this fotm, please sketch an outline of
property, showing the
proposed location of the
-to
dumpster(s). Give
distance from dumpster other buildings
and lot lines or
boundaries. Use back
side if additional space is
-1
needed.
Please return - this application with a fee of $25.00 per
establishment ($10-00 for temporary perm. t) to Town of North
Andover, Board of Health Office, Town Hall Annex, 1460 Main Street,
North Andover, M A 01845.
6H -ARLES T. MATSES REALTY REMITTANCE ADVICE DETACH BEFORE DEPOSITING
VENDOR NO.
VENDOR NAME
THANSACTION
DATE
REFERENCE
GROSS
AMOUNT
DEDUCTION
NET AMOUNT
CHECK
DATE
CHECK NO.
TOTAL
GROSS
TOTAL
DEDUCTIONS
CHECK AMOUNT