HomeMy WebLinkAbout0359 MAIN STREET (CENT.) - Health (3) 3 5 t�
ASSMSORSMAPNO° �)O
FARCELNO 0 -
------------No. ------------- Feel - -
BOARD OF HEALTH
TOWN OF BARNSTABLE
ZIppticationArVrtt Con5truct ion Permit
Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (,F�an individual Well at:
-I - =e^'r�rv� / - ---- - -------- - ---------------------------
G O Iu'�
Location — Address Assessors Map and Parcel
eTe/ Lz -- ----------------------------------
A
Owner Address
- - --- Ro. 96 o NI cLsG, oa G
---------�---- -- Installer — Driller Address Y9
Type of Building
Dwelling Ho" c-e -
Other - Type of Building---------------------------------- No. of Persons-------------------------------------------------------
Type of Well ------------------------------------------ Capacity=�----------------
Purpose of 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 Certificate .of Compliance has been issued by the Board of Health.
Signed ------- -/a A 1,96-----------
---------------------------
,.- date
-1 -- -lQ- -�-
Application Approved By---- -- - - - -
date
Application Disapproved for the following reasons:-----—-----------------------------------------------------------------------------------------
--------------------- ——--—-——--——-------------------------------------- ----------------------------------------------------------------------
�t` „ date
Lam/ 1
PermitNo. ------- -�-----��------------------ Issued------ -----�j-----�---�-------------------=----------------------
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate ®f ComPhance
THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired (mil
by------- eu•u _l/ —------------------------------------------------------------------------------------------------------------------------
// Installer
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 Nodls-''1 �-�F
Dated--------��---- ---- Z7
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE- --- —- —--- — - --- - Inspector------------------------------------------------ - -- --
1
No. � � � �, Y �R .,_ . o o� Feel' ---------
BOARD OF HEALTH
TOWN. OF BARNSTABLE' �r
f
ApplicatiduAr'Vel[ Cootruct ion Permit
Application is herebryr made for a permit to Construct ( ), Alter ( ), or Repair (4--an individual Well at:
7pr4J
r (!^ �u
- -------------------------------------------- ------- --------------------------- -
r � ,
Location — Address — Assessors Map and Parcel
_
s � ti.
_ � u�
� n
'eT % - -' ------------------------------------------- `f
I Owner Address
- - -----------------------
Installer - Driller Address
Type of Building
Dwelling //ou s --------------------------------------------------- "
Other - Typeof Building --- No. of Persons-----------------------------------------------------
TYPe-of Well- --- -- -:- -- - -= - -- Capacity------------------------------------------------------------------—
Purpose of 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 Certificate .of Compliance has been issued by the Board of Health.
Signed- • - 44
f - -- - ---
-- —/-----date
' Application Approved By
date
Application Disapproved for the-following reasons:-_--—---------------------------------- -----------------------------------------------
-- —-- ----—--—--------------------------------------------------------------------------------------------------------------------
` date
Permit No. --- ^-- - —--------------- Issued --- ��- - -
date
r a�ases+�asg mre eass=etac�a acme va�cs�+arr�_e�sa o$=AzZ s rartsmca own case sc 3czx awe cr�c
BOARD OF HEALTH J
TOWN OF BARNSTABLE
Certificate ®f Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired
bY-------_D 6-3 c u.0 N� --------------— — - — —------------------------------------------------------------------------------------------------
------ / Installer
YS-7 M C t t'v �� c e w*n(U r/Go /ut y
at- --' —-- ----- ---- —- --- -- ----------------------------------
l has been installed in accordance with the provisions of the Town of Barnstable Board ofgHeealtthh'PPrrivate Well Protection
Regulation as described in the application for Well Construction Permit No,10V -' Dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE- --- —----- - - --- - -- Inspector-----------------------------------------------------------------------------
m, .==-=M VMW==2k=U* e=20 m xc .ems ago r scar m
BOARD OF HEALTH
TOWN OF BARNSTABLE
lVell Con5truct ion Permit
No. --------------- Fee------ ---------
E
Permission is hereby granted-"-S Ca
r
to Construct ( ), Alter ( ), or Repair ( ✓J an Individual Well at:
No. --------------------------------------------------------------------------
! Street
as shown on she application for �11 Construction Permit
No. / - - - - Dated --------------
-------------
Board�� of Health
DATE
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