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"FAX 978z745-6343 ,3R w_2x yaXi�><,'�+.'j�rs��;v� �.._s •`^.. .F� �<
STAN LEY USOVICZ, JR - ' ;v a
JOANNE SCOTT;'•MPH, RS, CHO
MAYOR HEALTH AGENT
WELL CONSTRUCTION PERMIT
Location 4 Water Street
Owner Mason Tanning
Address 4 Water Street, Salem
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 # 4-03
Date issued 12/09/03
(Monitoring wells) (TDS Inc. — Reg. #560)
Health Agent
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DEC-05-2003 1147 SP INC 978 745 4881 P.01i01
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DEC —2003
CITY OF SALEM
CITY OF SALEM BOARD OF HEALTH BOARD OF HEALTH
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�l1ANNE 5C.11t 1.Ml'tl.n5.CNII Pax;(974)749 0]4)
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well Conetruoti n Permit Aa ication
Date:��I5 63 fee: S•' Cheok payable to the City of Salem (no cash)
yW e-ik ST Salem. MA. 0
Location: Address LwA f: Tel. DD
Owner. �Audati '�
MoNtTa,R(pb ' ,---
T e of weli� QtI G Weil use.:
yp Pump contractor:
Well Contractor: -T �e1('Qe� rnprufJb Address: NA
Address: Z. Phone;
phone:
Phone: 41 " 4b1"DaOh �d ✓'Y 1D4 A
Reg, M SW S a<. 0 }
Have abutters been notified? (y)— How?
in Inc space provWcd below(or on back)chow rho rocveen of Lha proposed well prior rand n.ro
existing or proposed above or below ground struGtwes. AOescnpms nt visiblebteotial source 0(Unf
land use wdnin(200)Met of the proposed welt IOCetion.which preen is PO
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8.0:N. use only. Check 0:
check date: Permit><:
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DEC J—2003
CITY OFM
BOARD OF E-A1 1