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3B
TOWN OF BARNSTABLE
LOCATION ,1/7// SEWAGE # �
VILLAGE 11)44,y 5 ASSESSOR'S MAP & LOT Y,v, -
INSTALLER'S NAME & PHONE NO. Gam/ //✓'.r9�rGc%i ,y '� 'd�'Y
SEPTIC TANK CAPACITYa
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LEACHING FACILITY:(type) j cro 4-a p (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER P17A,--i- q1 / on 0 �
DATE PERMIT ISSUED:_ Z7
DATE . COUPLIANCE ISSUED: /
VARIANCE GRANTED: Yes !/ No
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