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TOWN OF BARNSTABLE
BOARD OF HEALTH r
7 ii ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date Z q i Time: In Out
Owner�YJJ7 I)q Tenant
Address J I S eukK LA Address � Vi(� �ii4IV r;
►'V1-1�425 i�n�S �ITT �1/�,�5 i`�N S 1�/I/1rr�
Compliance Remarks or
Regulation# Yes NO Recommendations
2. Kitchen Facilities
3. Bathroom Facilities
4. Water Supply Ma 04. -n--
5. Hot Water Facilities
6. Heating Facilities '
7. Lighting and Electrical Facilities ,a
8. Ventilation
9. Installation and Maintenance of Facilities
10. Curtailment of Service
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal
17. Temporary Housing
18. Driveway Width
19. Number of Tenants Observed
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Number of Bedrooms Number of Vehicles Allowe ax)
Number of Persons Allowed max)
Person(s) Interviewed 4 LAM Inspector
If Public Building such as Store or Hotel/Motel specify here
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L01CATION L®7"'4v SEWAGE PERMIT NO.
6 .
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VILLA6.E
M/ RSTokwS 1V \ kl. S- V 648
INSTALLER'S NAME & ADDRESS
iTo f 4 N OF, m A F F- c
O E DY, 334 MA„R.s7 Q V S MILLSt ®z 6516
B U1*LDE R OR OWNER
DATE . PERN11T ISSUED
DATE COMPLIANCE ISSUED
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