14 INTERVALE ROAD pD
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CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT,MPH, RS,CHO - - NINE NORTH STREET
HEALTH AGENT Tel:(978)741-1800
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Fax:(978)740-9705
COMMONWEALTH OF MASSACHUSETTS
CITY OF SALEM
WELL DRILLING/PUMP TESTING PERMIT
Location: 14 Intervale Road
Owner: Mark Fournier
Address 35 Deer Park, Lynn, MA 01905
This license is granted in conformity with the Statutes
and ordinances relating to Well Permits.
Permit #: 1-01
Date: 03/09/2001
HEALTH AGENT
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WELL & PUMP, INC.
Reading, MA
Providing "Free Water'For Your Lawns& Gardens
Local:781-944-5454
Justin Cravens Fax:781-944-6625 FREE Estimates
Estimates Toll Free: 1-800-499-5000 Fully Licensed
Esti
�, Esti ates 409-6305 www.ireewater.com 8lnsured
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3v *� MAR 5 - 2001
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HEALTH DEPT
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET
HEALTH AGENT Tel:(508)741-1800
/(]I Fax:(508)740-9705
Permit# IA-97 Date
Application for Well and Pump Permit
A permit is requested to: drill a well Z install a pump_; other
LOCATION: I14 IN`T6K\fAL9- RI) : Lot# 6
Owner MARK FOyKN i� Address S 5 Da-K WK- Tel. 7$ 1 159-Z , 2-%9
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Well Contractor NVeD400 ORJ�fJWAdd. ILi3 H NW ST ki2b46.NdI-el. Soca 1199 5
Pump Contractor AjaWot1 Oa7fl)M? Add. iq:3 MAItJST NGsI/IkTel. 83 �P99 -46m
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