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TOWN OF BARNSTABLE
LOCATION Cl V k 1,k<—� 0 SEWAGE # �/
VILLAGE
ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY � 02D ►4-��u�J
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NO. OF BEDROOMS PRIVATE WELL PUBLIC YA
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BUILDER OR OWNER 14 1 4 /w.--l—r i
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: JJ + yJ
VARIANCE GRANTED: Yes No
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