2011 DISPOSAL SYSTEM INSTALLERS PERMIT-CORNERSTONE CONTRACTORS Al Commonwealth of Massachusetts
City of Salem
Board of Health Kimberley Driscoll
120 Washington Street,4th Floor Mayor
SALEM,MA 01970
Disposal System Installers Permit
DATE PRiT•TTED: 06/02/2011
ESTABLISHMENT NAME: Cornerstone Contractors
File Number:BHF-1997-000001 338 Grapevine Road
WENHAM MA 01984
LOCATED AT:
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes
SEPTIC INSTALLER BHP-2011-0459 Jun 2,2011 Dec 31,2011 $10.00
Total Fees: $10.00
PERMIT EXPIRES December 31, 2011
Board of Health
This permit shall be in accordance with the provisions of 310:CMR 15.00 and the Salem Board of Health regulations.
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CITY OF SALEM, MASSA.CHUS.ETTS
BOARD OF HEALTI3
120 WA5r3ENc,ToN STALL,:', VH FLaoR
i :PU3 .T�1'rT X]]1ISCOiZ 'Zr*k(978)741-1800
FAx(978)745-0343
MAYOR 1rawdjgftkmqDm
LAMY aiAUDIN,Its/",M,CF1.0,CP-T+4
HEAUR AGPENT
APPLICATION FOR DISPOSAL SYSTEM INSTALLERS FERMI T Fee:$10.00
In accordance with the provisions of 310.CMR 15.00 and the Salem Board offlealth regulations an application for a
L�sposal Works Installers permit in.hereby submitted:
Name of Applicant:: M,`14 Re,w..1 - --- -
(Print name of A,pplico.xt)
Address: Ad.
Print Address of applicant
Telephone: 7 �f --C/ter E-Mail "rr' / �-� [ r--c.a_�►:- �
Business Name:
Address ifDiffc=t from applicant:
I certify under penalties of Perjtuy,that I to the best of mar knowledge and belief have filed all state tax retum ot.0
have paid all state taxes required bylaw
For official Use only
r I
Amount Received: 1 �,� '��15� Received by: Le ! L o
Approved By: Permit#: 60 l - 1