Loading...
HomeMy WebLinkAbout0480 OCEAN STREET - Health 480 Ocean Street Hyannis nD A= 324-038 I � I _ o.----------------- Fee--------------- BOARD OF HEALTH TOWN OF BARNSTABLE 01pp[icationforlVell uCo0tructionPermit Application is hereby made fora permit to Construct Alter ( ), or Repair ( )a individual Well at: Location — Address Assessors Map and Parcel Owner Address --- --------------------------------— —_—_--------------- Installer — Driller Address Type of Building Dwelling-- ---------.—_—__ Other - Type of Building—=--------_____ No. of Persons-- Type of Well If"/p— - ---- Purpose of Well fCSL__—_--__---- 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 --- date Application Approved By date Application Disapproved for the following reasons: —Permit No. �00� date_: �d Issued---- --- - -- —--- -_—- --- -- date BOARD OF HEALTH TOWN OF BARNISTABLE C ertif irate ®f (Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (�; Altered ( ), or Repaired ( ) at—_— ci �nl �Ijns�al�leA�/.v 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 No. _----.--_-_-_-______Dated—_----------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE----__— - Inspector---------------- i No.2 UO -- -UG Fee-- BOARD OF OF HEALTH TOWN OF BARNSTABLE Z.pplicationArVell Congtruction,Vermit Application is hereby made for a permit to Construct (� Alter ( ), or Re air ( )a in Well at: Location — Address Assessors Map and Parcel Owner Address 5� ✓!•//i / 'C/!'///�r -------------------- --------------------- — ——--------------- Installer — Driller _ Address Type of Building Dwelling- ---------_—_____--_____-- ' Other - Type of Building-=---__--____ No. of Type of Well 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. %l��---- date Application Approved By date Application Disapproved for the following reasons: v' date Permit No.v zey - ©6 �___ __ ___ Issued------------------------------ date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (;-), Altered ( ), or Repaired ( ) by I S�r'�rL.f'/� 16,e// /0r,//;./ Installer yyD 0 C,��,� S� at—_— -- — � ^�. -- /P1--A-- ------ ------------------------ has been installed in accordance with the provisions of tie Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. _--_---_____________Dated----------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. I l ,r DATE __-- -- - Inspector BOARD OF HEALTH TOWN OF BARNSTABLE Ivell Con5truct ion Permit No.w 2Gtl�U G Fee- L -------_ wN Gnu Permission is he by granted U to Construct ( , Alter (�), or Repair ( ) n Individual Well_a Street - ---------------- as shown on the a lication for a Well Construction,Permit No.- 0 0�_-- Dated-- � L ZCJ6� ------------------------- DATE S /ZO -- Board of Health f _ ---- - \ N Q� .; x � ODo r—,NItDw _ n J , • w � w 00 O III1'iII illy CIO I ; . x o N o STREET -- + x x x - x X X X x X x x ---I x x - x x - I x x III I I1_ I x x ,, _ x I .............. `x ► — — x .......... _ ( D 3 _ I / N-o I I D � x oa�N Ln r I X / D , i w LP � liil IiI • I II Ililllllllllll I III I � / Ilol1 . , 1=111. 11111.III1 '! ,I _ II III .. . ti. SCALE 1"=80' iso I - - - - _ - - - - °n basemap:dgn 4/29/2009 9:16:37 AM