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APPL!CAT!ON FOR PERMIT
City or Town: Yarmouth
Date:t0 / L8 / 2023
permit Number: 103236
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A application is hereby made
bY: mou3sa kafal
Address: 601 Route 28 /Mobil Gas Station/West Yarmouth, MA 02673
For permission to; Underground Tank Removal Chapter 148 sec 38A
Name of Competent Operato
Date lssued-Rejected L0 / Lg / 2023 By
Date of Expiration
r: Western Mass. Tank Removal/Cape Farms Cert. No.
Fee: 100.00 $ paid
(Signature of applicant)
Due
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PERMIT
Date:to / ts / 2023
Permit Number (if applicable) 103236
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A this permit is granted
to: Western Mass. Tank Removal/cape Farms
For permission to: Underground Tank Removal Chapter 148 sec 38A
Restrictions: Strict and complete compliance with all federal, state and local laws, rules, regulations and codes.
Notify YFD before and after work is complete.
At:601 Route 28 /Mobil Gas Station/West Yarmouth, MA 02673
DIG SAFE NUMBER
Start Date:
Fee Paid $100.00
Signature of Official Granting Permit
This permit will expire on
Title
This rmit must be cons icuousl ted u n the rem tses
City or Town: Yarmouth