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A ' }, • + .{ ,, You are granted\al variance Co install aseptic-leaching pit::110.feet from �. » I,r = ;; , ,}t,.
" °r �} 1. + .�°'privaCe well;<in�lien of the required,,150 `feet, "at 1266,bfain StreeC, i,; �„ d. h
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4 No.
` DATE
OF,THE TO� TOWN OF BARNSTABLE FEE
OFFICE OF
MIL BOARD OF HEALTH
O� i639•O YAY k. 367 MAIN STREET
'F
HYANNIS, MASS. 02601
VARIANCE REQUEST FORM
All variance requests must be submitted five (5) days prior to the scheduled Board of
Health meeting. --\\ �
NAME OF APPLICANT e9 •-e✓ r� TEL. NO.
ADDRESS OF APPLICANT pO''I 5--if mot,e S j?v4--Z-�\
NAME OF OWNER OF PROPERTY
SUBDIVISION NAME DATE APPROVED
ASSESSORS MAP & PARCEL NO.
LOCATION OF REQUEST S`C` ` 2 1 Ca
VARIANCE FROM REGULATION (List regulation)
VARIANCE REQUESTED (Specific request)
XL3--e
' C?V'e-
REASON FOR VARIANCE (May attach letter if more space needed) SySt�rv� t:c.4cS
PLANS - Two copies of plan must be submitted clearly outlining variance requested.
VARIANCE APPROVED
NOT APPROVED
REASON FOR DISAPPROVAL
i
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Robert L. Childs, Chairman
i
Ann Jane Eshbaug h .
Grover C.M. Farrish, M. D.
BOARD OF HEALTH
_ TOWN OF BARNSTABLE
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