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UPC 10259 �Q
No.H� ` � �
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TOWN OF BARNSTABLE
LOCATION 051-- w. SAfts QE,D , SEWAGE #
VILLAGE 416g57-Drys 1At"S ASSESSOR'S MAP & LOT roZa2 '"00 r7
INSTALLER'S NAME & PHONE NO. 4AF — 0 1 7
SEPTIC TANK CAPACITY S'DD Ott-0XS �f S�.C- oN Ur how
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER WTI,
BUILDER OR OWNER TKE-400PAI"A MCrV DES
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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