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TOWN OF BARNSTABLE
LOCATION ,� i� �'� •' SEWAGE # ::5-"��'
VILLAGE C�11 �' �"' ASSESSOR'S MAP & LOT 03b
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (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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