HomeMy WebLinkAbout0120 NORTH BAY ROAD - Health (2) aD t- 0Oe—Alh E
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4015'Falmouth Road (Cotuit,Hardware)
Cotuit
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7` TOWN;.OF BARN$TABLE ;UNDERGROUND FUEL AND :CHEMICAL �STORAGE REGISTRATION
OWNER :AND .INSTALLER 'INFORMATION t
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TOWN OF BARNSTABLE — UNDERGROUND-FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
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ADDRESS: �/ !'�r �r ( C, t I/tI MAP NO. 7 PARCEL NO. �0
OWNER NAME: tntn(� �, (;4`j�(,'C C7 [ 4S /�(v. , • fi`lr � ��lct� VILLAGE:
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INSTALLATION DATE:` '' BY: i iC i-E L t._
ADDRESS: i i/`/ r /; tl r 1 _ CERT. NO.
-7 VI) TANK INFORMATION
LOCATION OF TANK:
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CAPACITY 4 ra r�!''j"-TYPE ' " (AGE'
TESTING CERTIFICATION C ] PASS 'C' ] FAIL' . DATE.
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LEAK DETECTION C/` CHECK IF N/A TY E/BRAND'
ZONE OF CONTRIBUTION C ] YES C ] NO DATE TO BE REMOVED
FIRE� DEPT. PERMIT ISSUED C/J YES C 7 NO DATE
CUNSERVATION /K3 CHECK IF N/A DATE i
BOARD OF HEALTH TAG NO. Cam) C 31 ]C ]C ] DATE /l_.1
r PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON T E B K OF THIS CARD