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TOWN OF BARNSTABLE
LOCATION aZ ORC—D . LN, SEWAGE # �S " I
VILLAGE fi�SSE -
SSOR'S MAP & LOTS!
INSTALLER'S NAME PHONE NO.Ao
Ake Irex V 2 .4 m
SEPTIC TANK CAPACITY 10a�
LEACHING FACILITY:(type) (size) 12 x y
c
NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER T w N
BUILDER OR OWNER S �/
DATE PERMIT ISSUED:
DATE .COMPLIANCE ISSUED:
'VARIANCE GRANTED: Yes No I _�
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