HomeMy WebLinkAbout0474 CRAIGVILLE BEACH ROAD - Health 1 C17a� �rc� �. gaol
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UPC 17734 '
No.2-13CR �tPo l l6614;
HASTINGS, MN
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No. -y-- ------- - Fee--------------------
BOARD OF HEALTH ,
.,� TOWN OF BARNSTABLE
� � � � Yitatiort r�erY t�or��tructiott ermit
Application is hereby made for a permit to Construct (Y), Alter ( ), or Repair ( )an individual Well at:
W }�� Ar_(e\Jl-bo Address _ Assessors Map and Parcel — -
--- - E I-J _ -
Owner ------------________ Address
Installer - Driller Address
Type of Building
Dwelling-,K----------------------------------------------------- ,�(/
Other - Type of BuildingNo. of Persons------�[--
Type of Well Capacity--
,� _ , ice, �, T„
— f
Purpose of Well----- p_P0
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 ertifi ate of Compliance has been issued,by the Board of Health.
Signed - —-- -_-_ —g` date e
Application Approved BY--- ---------
dati
Application Disapproved for the following reasons:-- —- - ---
�,
-- ' - date �—
Permit No. -----3 -- ----------- Issued------------------____—___ -- --------____
date
--------------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate ®f Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed (XI, Altered ( ), or Repaired ( )
E�_It �— C.� ��__s _l. [ ---------------------
by------------ --- ---------------
_ Installerat- _
- -
has been installed in accordance with the provisions of the Town of Barnstable Boar of Healt Pzi me Well Protection
Regulation as described in the application for Well Construction Permit No. � - ated—------------—_-
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE--------------------------------------- ------------------------------ Inspector---------------------------------------------------------------------------
_ J - ��
No. - g------L--- -"' Fee-------------=-------
BOARD OF HEALTH 7
TOWiN OF BARNSTABLE
Zipprtcafion-*rVell Con6tructionPermit
Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( _),an.individual Well at:
_ I...�-r''�7 /per�a t.r► t �_���_f��,ct,�,a �� ._,������--- ---f;��_�'J'4``�l _
' �o atioR A d� ress Assessors Map and Parcel 7 —
t13. -,---
` - ------- --------------------------------------------------------------- ==----:--_- --
/ Address
5�— C a '? i J�5�- -!—�' =>`V� 5-----
Installer — Driller Address
Type of Building
Dwelling-� -
Other - Type of Building------------------------------------ No. of Persons------- --------------- ---------
Type of Well-� — !E�-- ------------ Capacity-------L —
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 --------------
-
!/ 0 s date'
Application Approved By-- - �� fi� �l%?��`.—N�
— l 'datet /
Application Disapproved'for the following reasons:", —
--_-_---- - - -- -- - --- ---- -- ----------------------------------------------
date
Permit No.___ --j-r/lJ f/,--_ /--�f(\-=1=�------ Issued-------------- -- crate --- —-- —
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of Comprianre
THIS IS TO CERTIFY, That the Individual Well Constructed (X), Altered ( ), or Repaired ( )
s-"- �-- ------------------ ---__ —_ —
�. -
y— ---� Installer r�
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. 04 -bated- -----------
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
Veil Construction'vermit ,.
No. (7;r-f-- -----=---- 4wi�� Fee-�-----------/ JPermission is hereby granted—- =- -=_ r - - -------------------------------------------------to Construct ( ), Alter ( ), or Repair ( ) an Ind'vidual Well at-
No ANN61
� �)No. ----------------X-/_/?�%1 �.. I"f�,,Cl_l/ I/ 1 l_.( � �1�5 /�l" - m'-( t .r fir-`------.-----v--------tee r_.• r ,-c:-----'rf
Street
as shown on the application for a Well Construction Permit
No.--------------------------------------------------------------------------- Dated----------�-;--�--�------------------___ -v6k�n
Board of Healtli
DATE -- ` --
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