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TOWN OF B.ARNSTABLE
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LOCATION Pwg!07 wAy SEWAGE #
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VILLAGE A40,0AL.5 ASSESSOR'S MAP LOT „ (�
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY /,D 40
LEACHING FACILITY:(type).c-sgaloc as /O(Jc9 ��A�ca+2ds j� I''
NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER L&)e-:6g-o-
BUILDER O .OWNER J
DATE PERMIT ISSUED:
DATE .COUPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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