HomeMy WebLinkAbout0203 GREEN DUNES DRIVE - Health (2) 203 C-�rten
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No, -- --- - ------- Fee----- - --- ---._...-
BOARD OF HEALTH
TOWN OF BARNSTABLE
Application-*rlftl Cootructionpermit
Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at:
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Location Address Assessors Map and Parcel
---------------------------------------------------------—---------------- -----—— —---—-----------------------------—---—-------------—----—---------------------------T-----
Owner Address
�rieR_�C�9tJ =�R1���N --Se�U1�eS ---------------------------------------------------------------------------------------------------
Installer — l 'ller Address
Type of Building
Dwelling------------------------------------------------------------------
Other - Type of Building ------------------ No. of Persons------------------------------------------------------
1 611
Type of Well- r r( a ►®� --- - ------------------------
Purposeof Well----------------------------------------------------------------
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 Certif/,c,,e .of Comp ' nce has been issued by the Board of Health.
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Signe - - �- ---------—-'--------
a - - --- -
date
Application Approved By - - — - --- ------------------
date
Application Disapproved for the following reasons:-----------------------------—-------------—--------------------------------
----------— -- ------ --r-- — —--------------------------------------------- ----------
-- -- -----------------------------------------
�� ) r / date
Permit No. --�'u- ------- -- Issued---- L - - - - — -
da e
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of Compliance
THIS IS 0 FYI
tthi(Indi_ 'dual/Well C/omtr cte d ' Alt re �(�r Repaired ( )
by-------- - l--Y��f-------� `�/ ='L --- - ---
Installer
at- -— --- - -------- -------------------------------------------------------------------------------------------------------
has been installed in accordance with the provisions of the Town of Barnstable Boar of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No.4-- �ated--------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE- --- ---- - — - ---- — —- Inspector--------------------------------------------------------------------------
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r
a V . iT
NO -- --- - ------- Fee----- - --------._...__
BOARD OF HEALTH
TOWN OF BARNSTABLE
Application for lVell Con!6tructionperm t
Application is,hereby made for a permit to Construct ( ), Alter ( ), or Repair (` )an individual Well at:
?� __GRee0 D_vr es D)21Ve -" - - -- - -- -
Location 0 Address 3 Assessors.Map and Parcel t
------------ ----- —---— -- ----- -------- } — — — —--
,.
t caner Address
d�1►9eRl�l9N_ � l1►u---__Se�U1Pe
Installer l I" Address
Type of Building
Dwelling---------------------------------------------------------------
Other - Type of Building - ------------------ No. of Persons---------------------------------------------------
//
Type of Well ► -a�'t e - - -- - - Capacity----------------------------------------
-----------------------------
Purposeof Well-----------------------------------------------------------------
Agreement:
The undersigned agrees to install th aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regdl" tion - The undersigned further agrees not to
place the well in operation until a Certific to .of Comp ' nce has been issued by the Board of Health.
Sine - -= - ---- --- --- -- --
g e a date
Application Approved By
-- ------ - ----- ---------------- ------------------
date
Application Disapproved for the following reasons:----------------------------------------------------------------------------------------
- - ----------- -: - - - -------------------------------------- --------'da
-- -----------------------------------------
1
date
Permit No. - ---- --------------- Issued ---- / -- - ------------------------
e
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of Compliance
THIS IS O IFY, Atjh�Ind' 'd al Well Constr cted Alt re ( Repaired ( )
by- t ---------------------------------_--------
.o,
Installer
yy --— -- --— — ----- - --- ---------- ------------------------------------------=-
' has been installed in accordance with the provisions of the Town of Barnstable Boar of Health Private Well Protection
Regulation as described in the applicatio for Well Construction Permit No. ��ated-------------------------
THESIS-SUANCE 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 - lVell Construct ion permit
No. - - -- - ---- Fee----- - -----v i
e
Permission i hereby granted-- -t--- ---- - ------------- ----- --- ------- - ---- ----------------------- ---- - ----------
to Construct ( Alter ( ), or Repair( ) an Individual Well at:
-----------------------------------------------
Street
as shown t p lication a ell Construction Permit
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Board
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