HomeMy WebLinkAbout0423 SHOOTFLYING HILL RD - Health (2) a1A V �
I
J
i
N 77 Fee---:F--- -�
BOARD OF HEALTH
TOWN OF BARNSTABLE
Zipprication-for lVerr Con5tructionvermit
Application is hereby made,jor a•permit to Construct (,.�), Alter ( ), or Repair ( )an individual Well at:
- 7 ------Shy`---f.�---f-.�---�11--- -���� -------------------------=------------------------------------------------
Loc tion — A dress Assessors Map and Parcel
- ' r -- -____- - - - ------ -- ---- - ----------------------------
!/ tt
/l JJOwner � . Address
Installer — Dri er Address
T e of Building
Dwelling--- -------------------------------
Other - Type of Building ------------ No. of Persons------------------------------------------------------
,�7y -------------------------------
T e of Well= �- �_ �` -- - - - Ca acit - ---
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--imis � —
date
— — --- — — —Application Approved By .�.,�--- ------ --- --�- lit
date
Application Disapproved for the following reasons:---------------- --------------------------_______ _�_______—__________:
-----------------------—----------------------------------------—- ------------------------- ---------------------------------------------------------------------------------
+/ date
Permit No. ------------------- Issued te---- — — - --—-
da
BOARD OF HEALTH
TOWN OF BARNSTAB LE
Certificate Of Compliance
THIS IS O CERTIFY, That the ndividual-Well Constructed (rl), Altered ( ), or Repaired ( ')
Y- ,
— Installer
at
has been installed in accordance wit4e pli is�f the Town of Barnstable Board of Health Private Well Protection
p,
Regulation as described in the application for Well Construction Permit No llv o1 V- Dated- —"- ^' 57�j
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE- --- ---== -- —- - -----____ Inspector--— -- ---------------------------------------------------------
C��'-='-`-- `---- � Fee--�F�=-T-----���No.-
BOARD OF HEALTH- ,
TOWN OF BARNSTABLE
Appritat ion for lVerr Cootruction Permit
Application is hereby made for a•permit to,Construct (,/), Alter ( ), or Repair ( )an individual Well at:
�z1 �� �1�- --------------------------------------------------------------------------------------------------
Location — A dress Assessors Map and Parcel
-----------r?` / - --------------------------- -
Owner Address
------------------------------------------------------------------------------
Installer — D' er Address
T pe of Building
Dwelling -------------------------------
Other - Type of Building----------------------------------- No. of Persons---------------------------------------------------------
1
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 Compliance;has been issued by the Board of Health.
Signed-L _ -C�l /L�/Z(
- - -=------- ----------- -------------- ----------------------------
date
Application Approved B
date
Application Disapproved for the following reasons:---------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------- ------------------------- ------------------
�,� {� date
Permit No. ---Y-,�,G ------_/ �-- - Issued-------------- ------�""� -� - ----- -
date
v
- -BOARD-OF HEALTH -
TOWN OF BARNSTABLE
(Certificate ®f (compliance.
THIS IS TO CERTIFY That the Individual Well Constructed V/ Altered or Repaired
by—--���� �1 - 1'� ' ��--- � `2-! L1 Clr --------------------------------------------------------------------------
Installer
has been installed in accordance wit a p;eZions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit Nolil��,�"__V-----V-;27Dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE------------------------------------------- -------------------------- Inspector-----------------L------------------------------------------------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Vern Con!5trurt ion Permit
,:EZ
No.---------- ---------- Fee 9
------- - "=-f-`"��-
Permission is hereby granted--- -
to Construct ( ), Alter ( ), or R 4pair ( ) an In Ividu 1 Well at:
No. - .1 = -- ------° r '? - e ? _.-
� --------- - - -------------
Stt
as showJn, on the application for
a Well Construction Permit
No.-— --"~- --7 —------- —_-- --- Dated---- - ` = CL `F- - - - - -----
Board of Health
DATE -%'-�,- --.......-