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TOWN OF BARNSTABLE
LOCATION y/ Ryvea SEWAGE # �ZfS ov'
VILLAGE A/I,q ,e R �aAtS Milk
k ASSESSOR'S MAP & LOT d 7�'- O�Sr
INSTALLER'S NAME & PHONE NO. Iff tr��
SEPTIC TANK CAPACITY 1.
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED: "r I9 �
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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