HomeMy WebLinkAbout0056 COOK CIRCLE - Health : - fi Cook Circ1Q r
56 Cook,Circle Sewer Acct # D' '
;
n
o
o
t,
-
acn
No.---------�----- Fee------= ----
BOARD OF HEALTH
TOWN OF BARNSTABLE
2(pplication forlVell Construction-Vermit
Appli �n is ereb �de for a permit to Construct (A Alter ( ), or Repa ( )an individual Well at: --
a QC� n� -- 3a5�0 �--
Location — Address Assessors Map and Parcel
pWnc, Address
; ' � d2- ---------- - --------------------------------------- -- ----- - -
Installer — Driller Address
Type of Building
Dwelling ----- --- -----
Other - Type of Building----------------- No. of Persons-- ------------------
Type 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 unt' a ert' ' to f h 'c as been issued by the Board of Health.
-Slg er
---- ---- date ----
Application Approved Bdate
y
Application Disapproved for the following reasons: -- ---- --- -- --- --
----------- I --- date ----
Ot
Permit No.�+ ��3 — Issued------9 ----
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of �ompliante
THIS IS TO CEYIFY. That th�Individual Well Constructed (�j; Altered ( ), or Repaired ( )
—,------— ---+-r-------- — ----- -- -- — — -- - -- -- ----- --by____-_ 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 No.1�=��� '- l Dated----- -----
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE----- ---- -- - -- Inspector-------- - --- -- —------
,o o1C -O N 1 Fee------4j- -------
— BOARD OF HEALTH
TOWN OF BARNSTABLE
Application-*rVe1C Con$tructionPermit {
Applica ion is ereb ma4e for a permit to Construct (A Alter ( ), or Repa' ( )an individual Well at:
• i
_ 60lLC� tan►1 i� 32 5�03 fv
Location.-'Address Assessors Map and Parcel
oo--- Owner Address
---- ------------—-----------------------Installer Driller- Driller Address
Type of Building
Dwelling --- --- -----
Other - Type of Building-- - ------- No. of Persons-- ---- -------
Type of Well sad -- - Capacity- /_d �' �-7
-/ ---
Purpose of Well-- T �2
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 untiVa`Cert' . ate of Co 1' -c as been issued by the Board of Health.
S19-d -- ' 'L----
G� date
�tep
\` Application Approved By ---- -'-1--3-
date
Application Disapproved for the following reasons: ------------- ------ ---
----------- '' \\ - --- --------�------- date —
Permit No. - �00 3 -O N _- Issued------9-1 � -1 --
date
.__ :�..:._._.-..-_...ram._,..::� ...•..._a._. .�_.__.. � -- _---.. _---.__-`— -...------ ... .- '- -_-._ .._a_._�__ .._.. .. ...__ �_..�... .,..•c..• _.,-w-_.... ,._.... � .__..
BOARD OF HEALTH
TOWN OF ., BARNSTABLE
Certificate Of Compliance
THIS IS TO CERTIFY, t th ndividual Well Constructed (�, Altered ( ), or Repaired ( )
b � — — ---- -- ---- -- - — -- ----
\\ Installer
of ram!S
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 No. Dated----
1
' THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE----- -- — - -- Inspector-------- --- ------ ---
.4, BOARD OF HEALTH
TOWN OF BARNSTABLE
well Construct ion Permit
No. -- 3 -O 1 Fee-
Permission is hereby grantedp�' —__--_—
'� to Construct ( �};, Alter ( ), or Repair ( ) an Individual Well at:
C � k GI ��e �ya-.IV1i
No. -_—.�� ---------- - -----------------------
Street
as shown on the application for a Well Construction Permit
•
No.-- 3 -o y I — - Dated-
-- --------------------------
------IM�
=Heaith
-----------------------------------
D Board
DATE
�f
5 5 �"L'✓/ 3Yy `' tr ` t+ y,'t+ 1f"'N 1'+s z i /f/�r +<s
�' hNelson 'Bearse & 8lcharrd Lava. Surveyors V
3 .,
December 12:,• 1960 1 c u r'
Ilk
r�Y
t '
.•t t r ,+. r X� v;
z
, � �s� ..� -0 - �' Z•`'c, -�'r to c-
s�•yy .. .. 'SV�y K'
.t I
x s R IC,
t-
,r r°
Fill
In
ok et LX
G.
V. W 11SO
jr
iam F ,
ch
33.
J
.10
F
a 17t F �
i�
• off` e � ��'
gs
�44
Wi
44
:o lie
w ?9 �•iN N
M Q
N •
I �
O — a
q
00
I �
. E�•t9 ,� -i,�, a;, .. ago V � ; � : .
x 4-D N ,
43
a �0 � ;o
O;O
G
lip
Nis hi ho
• "�M/ R1C�.Cw. �17MY�w� se�.+_. di ....+..�...1.r..i�wy� 0AAA,^yV11