HomeMy WebLinkAboutCanoe River Campground - 12/31/2020®U
Town of Mansfield - Board of Health
Application for Campground Permit
Town of Mansfield
6 Park Row
Mansfip MA 02048
I hereby make application for a CAMPGROUND PERMIT, which expires on December 31 st of each year.
NAME OF BUSINESS: C a.h o 2 92 Je r C a P,A fI t-4 it wel�
ADDRESS OF OWNER: 3 rn l AA Cr v� 4 �f2�� O C� qe
OWNER: ave l � 2 �tro S' o > s a I'vv S i—`vM ` /i
BUSINESS PHONE: j O 6 ,-
BUSINESS FAX: -5-0 37
E-MAIL �J �s ree �C caAvo e-
ALT E-MAIL:
FEDERAL IDISS NUMBER:
NUMBER OF SITES:
by_
19-30
FEE: $75.00 Plus $1.00 Per Site TOTAL FEE:
PERMIT NUMBER: C-1
SIGNATURE:
DATE:
Please make appropriate changes. Sign, date, and enclose check payable to Town of Mansfield. Mail to: Board of
Health, Town of Mansfield, Six Park Row, Mansfield, MA 02048