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No. 4210 1/3 RED
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TOWN OF BARNSTABLE
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VILLAGE ASSESSOR'S M UOT 8E .
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INSTALLER'S NAME 6z PHONE;NO.
SEPTIC TANK CAPACITY
LEACHING FACI-LITY (t;pe) (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER' '
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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