HomeMy WebLinkAboutRibeiro Enterprises - 12/31/2020r
Town of Mansfield
qw o Mansfield - Board of Health 6 Park Row
9 Mansfield, MA 02048
Disposal Works Installer Application
LICENSE NUMBER:
APPLICANT: 7d), 4y
BUSINESS NAME:
MAIL ADDRESS:
CITY/TOWN
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STATE: _ ZIP CODE:
BUSINESS PHONE: � � �t(y� e041 BUSINESS CELL:
BUSINESS FAX:
E-mail:
Alt E-mail:
ID/SS NUMBER: gel - d—�d✓l%
LICENSE
HELD:
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Year Licensed
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LICENSE
HELD:
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Year Licensed
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Please submit a copy of the licenses held along with a contact name and phone number for each town.
References will be checked.
I have read 310 CMR 15.00, the State Environmental code; Title 5, Minimum Requirements for the subsurface
Disposal of Sanitary Sewage and the Board of Health regulation titled "Minimum Standards for the Subsurface
Disposal of Sanitary Sewage". I understand that deviation from them may be cause for revocation of this permit.
Permit Expires December 31 st yearly.
FEE: $ 100.00
SIGNATURE:
DATE:
Please make appropriate changes. Sign, date, and enclose check for $100.00 payable to Town of Mansfield. Mail
to: Board of Health, Town of Mansfield, Six Park Row, Mansfield, MA 02048