Incident Report a
Dartmouth Building Department
5„ 400 Slocum Road
P.O. Box 79399 508-910-1820
Dartmouth, MA 02747 FAX 508-910-1838
INCIDENT REPORT
Address ,9-,5 Sly/ t rs7/
Plat Lot UY / -
Date//L,3)0 V Time %,7 -,
--1
❑ Zoning ❑ Building A Electric
3
❑ Plumbing ❑ Gas ❑ Other m
k Permit Issued U Yes allo Date: ,i"-//-dK "
Parties Present F-4 Cl — p� G�� o:34 PIN -
Inspector's Name 4/-W '
Comments/Brief Description & ( pgt A: ,-/
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4�L 'ULLvcr� G�I ',�1�ti � t .� Clerk
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. 041fAild den 0247)1A Di G/t4
6 .
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Resolution � ���y�t-Q h �/`��T �/��
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kv/.17/07
cc: Log Book
Original to File
c.:Iwpdocslformslincident.rpt April 22, 1999