35-041 (16) THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
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...PRIPAM.PI�j FEE........................
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No.. )LIP ............................. OFN
..............7---- ujovaoat Ua
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Permission is hereby granted---------------- --------------- --------------------------------
I wa Os yf ern
rR a ndi ual _t ..............................................................
to construct .. ....7
...........
...............;4
.... ............ Street
at No.----.---- --- ------------- ------ Date
as shown on the application for Disposal orks Construction Permiylvo —7 . ......�A7........
.................... —.... . ... ....oard of Health
DATE.--•............./-1 ....................................
FORM 1255 A. M. SULKIN. INC.. BOSTON