76 LAFAYETTE STREET & NEW DERBY STREET - WELL a � CITYrOFrSALEM MASSACHUSETTS
OF HEALTH
y
WASHINGTON STREEM 4TH FLOOR
SALEM,MA 01970
TEL 978-741-1800
FAic 978-745-0343
WWW.SALEM.COM
Kimberley Driscoll JOANNE SCOTT, MPH, RS, CHO
Mayor HEALTH AGENT
WELL CONSTRUCTION PERMIT
Location: 76 Lafayette & New Derby Streets
Owner: Dodge Area LLC
Address: 17 Ivaloo Street, Somerville, MA
This permit is granted in conformity with the statutes and ordinances relating to well
permits.
Well Construction permits are non-transferable.
This permit shall be on site at all times that work is taking place. Permit shall expire one
(1) year from the date of issuance unless revoked from cause.
This permit does not constitute a Water Supply Certificate.
Permit#: 008-06
Date Issued: 7/6/06
(Monitoring Wells) (TED Inc. — Reg. #560)
HEALTH AGENT
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