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APPLICAT!ON FOR PERM!T
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City or Town:
Oate:
Permit Number: 101259
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A application is hereby made
by:
Address: 27 Crab Creek Ln /South Yarmouth, MA 02664
Yarmouth
03/25 /2Ot3
For permission to: lnstall Propane Tank
Name of Competent Operator: Peter Fruean
Date lssued-Rejected 03 / 25 / 2013 By
Date of Expiration. O4/25/2OL3 fss; s50 ' 00 $ Paid
Cert. No.
(Signature of applicant)
Due
115
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FP-006
(Rev.04/12)
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Application for Standard Permit
t Retum completed applicalion to:I
Permit Number:
3-t5-l\
In accordance with the provisions of M-G.L. Chapter 148, as provided in Section 31 38
"pplication
is hereby made
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DIG SAFE NUMBER
(Full Name of Person, Firm or Corporation)(Phone Number)
of 3
(Add Street or P.O. Box, City
for permission to (state clearly purpose for which permil is requested)
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or Town, ZiD Code)n ?rqE 6) wb ,?
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Name of Competent Operator (if applicable)@\ec-cerr. No. ?L,Ju{b."q c'c,+ Zto4ol^5-l-ro By
(Signature of Applicanl)5-l- r3 Fee Amount Paid $+
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PERMIT
FP-O06
(Rev.04/12)
Permit Number (if applicable)
ln accordance with the provisions of M.G.L. Chapter 148, as provided in
to
this permit is granted
DIG SAFE NUMBER
Start Date:
(Full Name ol Person, Firn or Corporation)
for
Restrictions:
at
(Street and # or Describe Location for Adequate ldentification)
Fee Paid $ _This permit will expire on
Signature of Official cranting Permit Ti e
t This permit must be conspicuously posted upon the premises F
City or Town:
Date:
Start Dale:
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Date lssued -Feiectgd
Date of expiration
A"
er
City or Town:
Date:
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