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TOWN OF BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION(,'
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OWNER AND INSTALLER INFORMATION
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ADDRESS: n �J l AVAC/�/� / ii
,� �e,�P�1//�/ �-.... MAP NO. i �� 1 PARCEL N0.7�}
OWNER NAME: ��%�C/e�_FL=�J /`—� • l U 5- VILLAGE: < " P .a_ l7`P"E'7,7e--
INSTALVATION DATE: /'i/ 7k BY:
ADDRESS: /.� fV �/19 kA)• /' d tN�i'r a l( /:) CERT. NO.
TANK INFORMATION
LOCATION OF TANK:
CAPACITY/JD Q TYPE AGE , .FUEL/CHEMICAL Off!
TESTING CERTIFICATION C I PASS C ] FAIL DATE s
LEAK DETECTION C43 CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION C I YES C k
NO DATE TO BE REMOVED �yll
FIRE DEPT. PERMIT ISSUED C ] YES C ] NO DATE
CUNSERVATION C CHECK IF N/A DATE ✓ ,C
BOARD OF HEALTH TAG NO. ool
]C ]C 71 ] DATE J U MA
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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CENTER
OSTERVILLE� ARE DEPART, «7 # _
PERMIT T0: INSTALL,;. ALTER ��, �..
FUEL. OIL BUItN1N0 EQUIPI�AENT6 e, jt
Date ... ...19....
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This is to certify that ..........•� Z.<, �Wc
all aster fuel oil burn r equip t •For .
permission,to Inst /
in a bu• d g on ...
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village of ...(. /d!G�. ••• ••• ••••• ......••• in accordance with an ap
<.+ plication on rile 'in this office, and subje t to the provi 'ons of Chapter 148,
Gen. Laws, and Regulations made un er ut ority
T PERMIT EXPIRE .. D1 me.. . ....
He Fire
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E� IOSTERVILLE FIRE DEPARTMENT14" r
PER ,3 FORSTORAGE STORAGE-,- F FUEL OIL
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In accordance with?provisions of Chapter 148, Ci:L., and Regulations
made under authority thereof.
} y Name .. �Iac�11� ster ; • Nome Maurice DLifour
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tu:xxier o: oacupanti - - - (Installeri
Address$ y....T��,..R:.�'.eAt.Qr,.XFU.1§!Address AN:..01.d...��fi�....:��,..,....Fal.
Burner Storage
Make `
Type of Tank .................... ................
+.�N� , .Manufocturer 44314e• Ia om� Eguip;; Capacity ... .OnO, gals. (or) Size............
{Y;FF;,'-,;Model No.`5or Size .... Zr . . ............. .: Location, rg '.41z??d..
%Type ( 1 ..... Masi. Approval No: 4 .. ...
Permit issued ..: -.. 1. 7 .:. 5 �R. ... ''��' 1n 4n,:..Chief
t .�• ,,;,1a,t ,-,(Head_:.of ire epar e `
40,
JgI�`a y (THI'i PERMIT MST SE CONSPICUOI ISLY€PASTED UPON E PREMISES)
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