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O-TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
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` OWNER AND INSTALLER INFORMATIO �J
ADDRESS: �n yI V MAP NO. J91 PARCEL NO.
OWNER NAME: VILLAGE: mley U'if,
INSTALLATION DATE: BY:
ADDRESS: CERT. NO.
Ppv tX o -7 � �� TANK INFORMATION
LOCATION OF TANK:
CAPACITY TYPE L AGEaUUEL/CHEMI
CAL
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TESTING CERTIFICATION C ] PASS C ] FAIL" DATE
LEAK DETECTION CY] CHECK IF N%A TYPE/BRAND
ZONE OF CONTRIBUTION' C I YES CX] NO DATE` TO BE REMOVED / / t
FIRE DEPT. PERMIT ISSUED C I YES C ] NO DATE
CUNSERVA?ION CI CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. � ..0 7 C ]C ]C ] DATE . J
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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j CENTERVILLE, - OSTER.VILLE`FIRE DEPARTMENT
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PERMIT FOR ,STORAGE OF' FUEL OIL
In accordance with provisions of Chapter 148, G. L., and Regulations
! made under authority thereof.
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Name . )f'. ....U.T—L.... ............... Name .J���`.......�� t ►v
(oQwne�r,or occupant) (Install )
Address ........ Address ( b�!!... ? r(^.... ...V4.R..
i Burner • Storage
Make ........ 4'U.TT............... ............. Type of Tank .....AFXXe,SZl G...............
Manufacturer ...:- ................................. Capacity .............. gals. (or) Size............ j
Model No. or Size ........... Location��............ �1�3:� / . ....................
TYPe... v............... Mass. Approval No. ..,7 ...... j
Permit issued ...��.,/.��'/7C............ .... 1Jc.In.V\...Yll....1'.�9.R.R.e IAA 1.
/ (Head of Flre Departme
(THIS PERMIT MUST BE CONSPICUOUSLY / TED UPON REMISE
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