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BARNSTABLE
A = 278 - 028 / \
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TOWN OF BARNSTABLE g/ °
SEWAGE #
LOCATION 'I n �U /VL� '/�-
I l S
VILLAGE, � ASSESSOR'S MAP & LOTM"W:71%29
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No