HomeMy WebLinkAbout0213 OCEAN STREET UNIT BLDG 1 UNIT 102 - HOTELS/MOTELS (3) ��Q-Y''n's �arb�r� ��-5-��
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BOARD OF HEALTH
TOWN OF BARNSTABLE
ZppCication-*rIftl Con5tructionVermit
A plica_tiioon� is hereby1V.m�a..d.'e forr1a permit to Construct ( ), Alter ( ), or Repair (� individual Well at:
QSt111�17.1_lW—L_![1J Gi_K"1=_last—��� tk=1 --- — -- ---- P —__ ---------------
Location — Address Assessors Ma and Parcel
--------- ------—-----------—-- — ---------- —
Owner Address
Installer — Drill r Address
Type of Building
Dwelling__ -- ---------------------------------------
Other - Type of Building----------------------------------- No. of Persons---------------------------------
tl
Typeof Well- ------------------------------------------------------- Capacity---------------___ - -_— ----
Purpose of Well--...� �- �b�- - --- - —
Agreement:
The undersigned agrees to install the aforedescribed.individual well in accordance with the provisions of The
Town of Barnstable Board of Health rivate Well Protection Regulation — The undersigned further agrees not to
place the well in operation until a tificate of ompliance has been issued by the Board of Health.
Signed- ----- -----
a�te
Application Approved By4j
date
Application Disapproved for the following reasons:—------------- ----------------------- ----- ------------
--= -- -- -- --- - -------------------
—- --- - --- — - — ---— -------------- -
date
��s
Permit No.-------- Issued----------- ------
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate ®f Compliance
THIS IS TO. ERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired
Mc_kUY1C¢ Ce ------------- 11------
Installer
at- --�( ►d�C�3_►_1�t1- � -=1�T -�r (1� �--- ---- _____-_
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, d�^-, £ Dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
- - -- Inspector— - —----- --__ — -- - -
DATE------------------------------------------- -
No. BOARD OF OF HEALTH
TOWN OF BARNSTABLE
01pplitat ion-for Vell Conor' uctionPermit
A plication'is hereby made for a permit to Construct ( ), Alter ( ), or Repair (�/)an individual Well at:
Location — Address Assessors Map and Parcel
— — ------------------------—----------—— — — -- — ----—---—-----—--------—--------------- -- —--—--_— —
Owner Address
---------------------------------------------------------------------------------
Insta ler — Dri11jEr Address
Type of Building
Dwelling - ----- - —-- ---- -
Other - Type of Building ------ No. of Persons--------------------------_------------------_____
�t
Type of Well ------;__ -- --- --- - Capacity-------------------------------------------- —----
Purpose of Well- r� -- -- -- -
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health, rivate Well Protection Regulation — The undersigned further agrees not to
place the well in operation until a Cie tificate of ompliance has been issued by the Board of Health.
Signed v -- 'L ----------------------------- :_Z4i a
Application Approved By 'date
Application Disapproved for the following reasons:---------------- ____________—__-- —
i � .
---------------=----------------------------------
--------
--------------
-------
------
----------
----
------
---------------
----------
------
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----
----------
date
� `� v � - - Issued — - ?-_ !
Permit No.----T.------------- date
BOARD OF HEALTH
TOWN OF BARNSTABLE
C ertlf irate Of Comphance .
THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired (Vr
Installer
at_ ` —� �` � ^� 1 �- ( 1n"`mil --- = t`-'3-`9----- ------------------------- ___—_
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 AV 7___ Y 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
Ivell con5tructionVermit
�_ __ �
01
No.- -- Fee °—------------
Permission is hereby granted (X.CJI-----------
to Construct ( ), Alter ( ), or Repair ( an Individual Well at-
No.No. -- c1 i��� rr l W _t--- _ _ 1� . 1''t- - i -------------------------------------------------
— -
Street
as shown/on/ e application for a Well Construction Permit
No.---�f �—f/_ �7'— ----— -- Dated ---= ---— "— �"
('
Board of Health
DATE
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�F _ __ _ RECEIVED JAN 2 5.1963
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