HomeMy WebLinkAbout0130 NYES NECK ROAD - Health (2) c��- C�`a-=�;-- O�1 --
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No. - - ---- Fee -- -- ---
BOARD OF HEALTH
TOWN OF BARNSTABLE ,
Apprirat ion-*rVell CongtructionPermit
Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (3/)an individual Well at:
---------------------------- ------------------------------------------------------------------------------------
Location — Address Assessors Map and Parcel
— ®soO AU �eS /%J z C LJ
��e''�--L���`—�tL&AA---- -- —— — —— — — — -------------�' �— --—— — ——
Owner Address
of-JI- ---- -- -- — ` 6 - ------------�-
Installer — Drilled Address
Type of Building
Dwelling ---------------------------------------------
Other - Type of,Building--------------------------------- No. of Persons---------------------------------_______
Type of Well pJ C ----- —— — —-- - 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 C pliance has been issued by the Board of Health.
Signed f - •� ------=- -
'_ date.
Application Approved By---
datEf
Application Disapproved for the following reasons:----------------
—--------- - -— - — -- --- —---
date
Permit No. -- Issued
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certifirate.®f Compliance
THIS IS PV`�FERTIFY.,
johat the vidual Well Co tr ted ( ), Altered ( ), or Repaired-----------L - ---- ---------- ;-------------------------------------------------------------------------_
Installer
at—_____ .� - - - �} - - - -
has been installed in a cordance with the provisions of the4own of Barnstable Boa f Healt rivate Well Protection
Regulation as described in the application for Well Construction Permit No. ll bated------=—
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE-------------------------------------- ---------- Inspector-- --- - - - — ----- ----- -
,�
Nolow
c �? — C�
.---��
-------7--- ----- � Fee- _ -�----------
BOARD OF HEALTH
TOWN OF BARNSTABLE
���Yicatiori,�or�eYi �ot��truction�er�nit
Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( V)an individual Well at:
------------- ---
Location — Address Assessors Ma and Parcel
---------------- ---- — - --
Owner l/ Address (�g
-----------------------
Installer_ Driller Address
Type of Building
w Dwelling-------t'° `s------------------------------------------- "=
Other - Type of Building No. of Persons---------------------------------------------------
Typeof 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 C mpliance has been issued by the Board of Health.
Signed---- -
--- - date
Application Approved By-- -----. --�- -- �`; date ,
Application Disapproved for the following reasons:--------------------------------------------------------------------------------------------------------------
_ a
a- jr -
Permit No. � a-f ; Issued I/�/__`,^>-.!_=/' -date - ='
/date
BOARD OF, HEALTH
TOWN OF BARNSTABLE
Ceutificate ®f Compliance
THIS IS O`CERTIFY, that the Individual Well Corrtr cted ( ), Altered ( ), or Repaired ( )
by--------- --.-4
/`- IInstaller
at-------- --- _(� `Vr -lK_# l m - B - -
has been installed in accordance-with the provisions of theVown of Barnstable oard-oof-He/al�th�Private-Well Protection
Regulation as described in the application for Well Construction Permit No.U—N-1� -7 ter- Dated--------------------------
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
ell Con6tructionVermit
t N --111_ ---_ Fe --r "u_-�-
1 0• y V m e
Permission is hereby granted i_I(� / �:.1 L ./ O 'l11 - ' -----------------------------------------------------------
to Construct ( ), Alter,( ), or Repair ( )) an Individual Well at:
S�eet
as shown on the application for a Well Construction Permit
No.- -- �� ��]_ — _t-�_—- —--- -- - - Dated -- --- -----------------------
t
A 4
Board of"Health
DATE - 4- - -" -----------------------------------------------