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Septic As-Built Request
TOWN OF PLYMOUTH
11 LINCOLN STREET, PLYMOUTH, MA 02360
BOARD OF HEALTH
508-830-4090

SEPTIC SYSTEM AS-BUILT REQUEST

        DATE:______________________________     FEE: $10.00___________________________
                                                                                DATE PAID

                _______________________________________________________________________________
        NAME OF APPLICANT               STREET          TOWN            ZIP

        TELEPHONE NUMBER_______________________________

        
        CIRCLE ONE:

DO YOU WANT TO PICK UP RECORDS OR HAVE RECORDS MAILED?


MAILING ADDRESS____________________________________________________________
                                STREET                  TOWN            ZIP

SEPTIC RECORD REQUESTED:

_______________________________________________________________________________
                STREET                          MAP                             LOT


DO YOU NEED SPECIFIC INFORMATION COPIED?




___________________________________________________________________________________

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THIS SPACE FOR OFFICE USE ONLY








DATE PICKED UP___________________________       DATE MAILED___________________________


Town of Plymouth, Massachusetts  11 Lincoln St., Plymouth, MA 02360  PH: 508-747-1620  FAX: 508-830-4062  E-Mail   Website Disclaimer