22D-066 (4) NOV 1 l
L City of ampton 212 Main Street, Northampton, MA 01060
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Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111 , S 150A.
Address of the work: S l
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The debris will be transported by:
Ddada-7 Thayer
The debris will be received by: 41&.,a f b=r Ke n.rCt#1
Building permit number: ) I! _ � -
Name of Permit Applicant L/4u � 5
Date Signature of Permit Applicant
01 �u wi�15
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