HomeMy WebLinkAboutCanoe River Campground - 12/31/2021own of Mans&ld'/, , .
Town cif ,Wan.vjie1d �- Board of llealth Js ? ark Row Ali
Man ' , MA 02048
I hereby make application for a CAMPGROUND PERMIT, which expires on December 31st of each year.
NAME OF BUSINESS: 6!anG e K 1 VY G rY� p r� vt1�
ADDRESS OF OWNER: .3 .7 rn, ,ST
OWNER: STar I Ih Xnc,
BUSINESS PHONE: Sd 8 - 3 3cl- (a `16,2
BUSINESS FAX: So 8 3 3 Y - 5'd .3 ]
E-MAIL: O"FFIC'e L eayloe rI Vt r 9 Coi,-1
ALT E-MAIL:
FEDERAL ID/SS NUMBER: Z% 2 3 7 S57
NUMBER OF SITES:��
FEE: $75.00 Plus $1.00 Per Site TOTAL FEE:3��
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