35-014 (4) THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF H LTH
"'� OF..... . ... ... �"
No....../.C...�._ FEE` S
Disposal rk zt o#nl ivit Vami#
Permission is eby granted.._..... -------------------------------------------------------------------
to Construct or R �ir ( -w-individual Se � f�isposal Sys roa t r at No.--•---• � ""` --•---k" • .. R.l `
Street
as shown on the application for Disposal `'Forks Construction Permit No..1 .._'. ted . __ ..... ............
-------------------------------- --- --- - .-- ---•----------
�/= Boar of alth
DATE---------------- -�------------------.._...._ /Q
FORM 1255 HOBBS & WARREN, INC., PUBLISH E S