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7 CEDAR AVENUE SEPTIC ABANDONMENT 11-24-21
00 CITY OF SALEM, MASSACHUSETTS lu BOARD OF HEALTH 98 WASHINGTON STREET,3RD _C E I V E® Pub&Hedth Prevent.Promote.Protect. TEL. (978) 741-1800 KIMBERLEYDRISCOLL healthLg)salem.com NOV 2 4 2021 DAVIll GREENBAUM MAYOR HEALTH AGENT CITY OF SALEM BOARD OF HEALTH Application for Abandonment of Subsurface Disposal System Fee: $50.00 I, b s'Lr Mackrte"? herewith apply for a permit to abandon the Sub-surface sewage disposal system located at c �f Name of licensed drain layer: J Phone Number:��6!— 7 —O?(06J If tank needs emptying, name of septage hauler: W(kdr i (Septage hauler must be licensed by the Salem Board of Health,copy of the Pumping record has to be provided at time of abandonment) Date:/! ? /'6_�©� Signets: 2� (owner/ licant) FOR OFFICIAL USE ONLY Amount received: 4,.�6, . By: Date abandoned: Ili y Witnessed by: I I