HomeMy WebLinkAbout0025 BEE LANE - Health (2) � � ��
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BOARD OF HEALTH
TOWN OF BARNSTABLE r'
Zipplication-*rVell Con5tructioupermit
Application is hereby made for a permit to Construct ( ), Alter 'or Repair (k)an individual Well at:
---------------¢ 2 iv -------------�.�C1. /M - -----------------------------
Location — Address Assessors Map and Parcel
--------------------------------------------- ---------------------------------
Owner Address
J01
Installer — )7riller 1- LtS ----—------------------------------------Address---------------------------
Type`of Building j
Dwelling----! �----------------------------------
Other - Type of Building-- -- -= — -- No. of Persons- - -------------------
T e of Well-- 5r�_l_ >t�?_T_LA�...__-___________-__--_ _ � •
YP ------ Capacity------------------------
Purpose of Well DkiL1 _Xi-N�------ •� .
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of He ri Protection Regulation — The undersigned further agrees not to
place the well in operation un ' a Cer a e o omplianc s been issued by the Board of Health.
Signed— - --
ate
Application Approved B
PP PP Y--- — ---- - ----- -- - —- -- _ _
date
Application Disapproved for the following reasons:
------------------------------------ -------------------
date
Permit No.------ ----- �- - — ------------- Issued -- ------ -f c1 u
• � date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of Compliance
THIS IS TO CEZTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( )
------------- ---------------------------------------------------------------------------------------------------------------------------------------
Installer
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Re ulation g as described in the application for.Well Construction Permit No.C--b.--=_X-Lf----Dated--:--2/n/_,3_U
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE-------------------------------- ------------------- Inspector------------------------------------------------------------------------------
J
Ak
r
No.------------------ Fee_=---------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Application-*rVell Cootruction Permit
Application is hereby made for a permit to Construct ( ), Alter ( ), or,"Repair (X)an individual Well at:
Location — Address Assessors Map and Parcel
P, lv
Owner LIT T Address
t
(�.�--tom:�l S ---------------------__—_ _____-_____------
Installer — Driller _ Address
Type of Building__
L L
Other=-Type of Building----------------------------------- No. of Persons--- P�- -- -------- -
a1 1JT I A� --- — Capacity- — -- y --
Type of Well—_�__---- ---------------------- - G ------------------- --- ---- -----'--'�-
Purpose of Well-��--� -N� �*__h/-71<1___ ___
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of.The
Town of Barnstable Board of Hea-lthiivate-We'fl Protection Regulation — The undersigned further agrees not to
place the well in operation untila Certr ate of Com liaace_has been issued by the Board of Health.
Signed— — =-- ----=! ------- — -
date
Application Approved B -`"' 6
date/
Application Disapproved for the following reasons:------w-------------------=-----------
- - -------------- ---
71
date
Permit No.------ —0- --_—_—___ _ —___ Issued---________.
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( )
vtin� � n �
-------------- ----------------------------------------
Installer
at--------,-�—=�--------------------- -----�------"'r-------------------------- -------------------
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No. -'�?- --Dated -9�=0 !-=-U
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE--------------------------- - -------------- Inspector---------------------------------------- -----------------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
i
Vell Con5tructionPermit
No. ---------------------- Fee-----------------
Permission is hereby granted------------------- -- -------------------------------------------------------------------------------------------------------
to Construct ( ), Alter ( ), or Repair (—)-a}i jndividual Well at:
No. - - -7�---- -----L = -�+'�G`vt f
--------------------------------------------------------------------------
-------
Street
as shown on the application for a Well Construction Permit
b r--'� --7/ ` �1�r
No------ ------ - -- - ------ -- Dated — — - — ---0 ------ ----
- ----------------------------
� Board of Health
DATE----------------7-��`�q/�-------------___----------------
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1
.77
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