HomeMy WebLinkAbout0041 ADMIRAL'S LANE - Health (2) �1�dr�yra-1s Ley, e,
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No. 103'tA
2-153L
MAnr IN I,ISA
GIT ORGANIZED AT SMFAn.nnU
TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
MAP NO. PARCEL NO.
ADDRESS: 4
i N VILLAGE: ; �'`T:..; :��r l`,�
OWNER NAME:
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INSTALLATION DATE: BY:
ADDRESS- CERT. NO.
TANK tNFCIRMAT r
LOCATION OF TANK:
CAPACITY TYPE \ :��� ' AGE ` `� FUEL/CHEMICAL
TESTING CERTIFICATION C ] PASS C ] FAIL DATE y
LEAK DETECTION C ] CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION [A YES C ] NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED C ZYES C ] NO DATE
LUNSERVATION C ] CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. ]C ]C ]C ] DATE
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PLEASE PROVIDE A SKETC SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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CENTERVILLE OSTERVILLE FIRE DEPARTMENT
r .,
PERMIT FOR STORAGE OF, FUEL OIL
In accordance with
�- provisions of chapter 14s, d. L., and Regulations
made under authority thereof.
Name ..RQA...S,ja,P,JpL #
(owner or occupant) . •• Name .rSSiLlf�4�.@T.. S...�# I.Qr
Address A.1.....�.4�ID,�rfkjp wg�. ..... (Installer)
Address ...Q4.�$#�..►�ti.•.+... 3t # r9
Burner Storage
Make ....i@gkett
Type of Tank „ROUn.d
- Manufacturer .�A.C�A:�.�..... ... � ........................
.�,�''......... .... .... . Capacity ..2QQQ.. gals. (or) Size............
Model No. or Size .. Location ... Q7ld..
Type..: Ct }.........
Mass. Approval No. ....���......
Permit issued f0 ZY? ,
....... ..a ..K•.. R�N.G Q
ead of Fire Depar ent �
"r .............................................. ............ . By .. Cam................
i (THIS PERMIT MUST III CONSrICUOUfI POST U►ON THE PREMISES)
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