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APPLICATION FOR PERMIT
City or Town:
Date:
Yarmouth
09/L8/2Ot2
permit Number: 10115'l
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A application is hereby made
by:
Address: 477 Route 28 RT /West Yarmouth, MA 02673
For permission to: Above Ground Tank Removal 527CMR 9.02
Name of Competent Operator tank removal service 508-778-8265
Date lssued-Rejected 09 /!8 / 2Ol2 By
Date of Expiration ' 70/:..8/20\2 Fee: Ss0'00 $Paid
THEUOl
ROUT280778
Cert.
(Signature of applicant)
Due
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PERMIT
09/L8/2OL2
Permit Number (if applicable) 101 1 s 1
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A this permit is granted
to: tank romoval service 508-778{265
For permission to: Above Ground Tank Removal 527CMR 9.02
477 Route 28 RT /West Yarmouth, MA 02673
DIG SAFE NUMBER
Start Date:
950.00 expire on 10l1Sl2O'12
Signature of Official Granting Permit
This permit will
Title
This permit must be conspicuously posted upon the premises
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City or Town: Yarmouth
Date:
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:
Fee Paid $
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