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No. 2-153LY
UPC 12934
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SUSTAINABLE
FORESTRY
INITIATIVE
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TOWN OF BARNSTABLE
LOCATION fJa akl— SEWAGE #
VILLAGE 6 ASSESSOR'S MAP & LOT 11 j
INSTALLER'S NAME.& PHONE NO.
SEPTIC TANK CAPACITY /000
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS -3 PRIVATE WELL O PU�WATER
BUILDER OR OWNER J-D 0�
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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