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TOWN OF BARNSTABLE
LOCATION �S—O Ck-I SEWAGE #
VILLAGE ����[\S ASSESSOR'S MAP & LOT.�(-)7-
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) 2- (size) 1&400
NO. OF BEDROOMS—PRIVATE WELL OR PUBLIC WATER\ L.
BUILDER OR OWNER \-kfyR CEy y El L�LPG
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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