HomeMy WebLinkAbout0181 ELLIOTT ROAD - Health (2) i
PARCELNO ! Q
No. - — -�'-`='� �` Fee---
BOARD OF HEALTH
,TOWN OF BARNSTABLE
01 ficatton forlVeff Con5truction3permit
Application is hereby made for a permit to Construct ( ), Alter ( )—or Repair ( )an individual Well at:
'RIND
---------------------------------------------------------=---------------------------- -------------------------------------------------------------------------------------------
Location — Address Assessors Map and Parcel
' —L' '-C/ --------------------------------------- ?[U —�2��-------CF lz t)i 4.
-
Owner Address
DO5V - - -��-�-------- _I�' -ruJ---
Installer - Driller Address
Type 1of Building
Dwelling------------------------------------------------------------------
Other - Type of Building---------------------------------- No. of Persons--------------------------------------------------------
Type of Well_T-i -l{2_? /0�----------�-'--- Capacity---------- ----------------------------------------------------
Purpose of Well-----T-A-1Z-Ii:. 'T74L,0------------------
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation uyfill Certificate of ompliance has been issued by the Board of Health.
Signed ----- - --�---- ---���-- =`=-----------
. . YK 14- i e a date
Application Approved By� ------- '
---- ------------------------
date
,.. Application Disapproved for the following reasons:---__________________________________________________________________--____-________________--------
----------------------------�--------------------------------------------------------- ----- ------------------------------------ --------------------------------------
date
Permit No. - ----v-----------
---------
------
Issued ----- 6-----------_ - - - -
date
BOARD OF HEALTH
s
TOWN OF BARNS'TABL, E
Certificate (Of Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed (Altered ( ), or Repaired ( )
-----------------------------------------------------------------------------------
Installer
- LL_I O 1 -- t
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 N14t ted--, --------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE------------- --------------------------- Inspector- - = -------------------------------------------------------------------
3
/R7
-- ----- - Fee--------
i BOARD OF HEALTH
TOWN OF BARNSTABLE
Appritation-*rIftl Corif�tructionpermit
( lid f2cod
Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at:
1���—r-_L L/n--1 l — — - ----- - ----------------------------------------------------------------------------- __
Location — Address Assessors Map and Parcel
� e v u�c_L,►y ------------- -- —--— __ L1�_ —i�L _--�_E �
Owner Address
7 f._S_r�► �n2 —c v mac. !'--=�r../- ------------- —��- -�2c4�l r �? -�'--�`� - Q-�= 2U���a S�
Installer — Driller Address
Type of Building
Dwelling--------------------------------------------------------
Other - Type of Building------------------------------------ No. of Persons--------------------------__—_—
f�
Type of Well ------- Capacity------------ ------------------ -- -- — -—
Purpose of Well -�-.`�"�ice- ���--------------------
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation. — The undersigned further agrees not to
place the well in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed- — --- -- -<_— � z_' ^� ------------ --L Jc� IC7
Y✓1 l4 1 6 C7 date T'
Application Approved B — ----__________ _ __
date
Application Disapproved for the following reasons:--------------------------------------___—_____ _ -
-_ _ ___- ---- —-—------------ -----------___ - —- -- -- —- --- —
date
Joe
Permit No.--Az''- -- z� - Issued---------
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed (—)�Altered ( ), or Repaired ( )
---
---------------------------------------------------------------------------------------------------
Installer
at _—__—
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 PermitOf
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY. e
DATE - -- ---------------------------------- Inspector- - -
_ _--- ------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Very Con5trurtioniktmit
No. - ------ --'� / Fee
Permissionis hereby granted-------------------------------------------------------------------------------------------------------- - --- - ----
to Construct ( , Alter ( ), or Repair ( ) an Individual Well at:
No. ---- k3D------ C-jg�<c>_ T K Pz U( L,L(r -- —- ------
Street
as shown on the application for a Well Construction Permit
No.- ---------------------
Dated ' _
----------- -------
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DATE--------��-�-`-�-�-J--6 --------
-------------
Board of Health----- --
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