BP-83225RESIDENTIA1n Phasarl Annmunl tpintt .,� .q) l
11.1 Property Address: IQ 123 mf<u f(s I i ILS 1.2 Assessors Map & Lot Number:
It CA
Contact Person: rc,4 V t he �t Map Lot -
Phone Number: 570
1.3 Historical District *es ❑ No
1.4 Water Supply (MGL c40 s54) 1.5 Sewage Disposal System: Year Built
❑ Municipal ❑ Municipal ❑ Altering more than 25% per side of building
Private Well IKOn Site Disposal System Has application been submitted to the Historic Commission?
0 Yes ❑ No Date:
1 �
eCONSTRUCTION PLANS F-1 SITE PLAN ENERGY REPORT