HomeMy WebLinkAbout0067 OLD HARBOR ROAD - Health 6 ' Old Harbor Roa
Hyannis, MA
5EWER
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____ ____
No.--- ------------- Fee
BOARD OF HEALTH
TOWN OF BARNSTABLE
Zipplication,forlVell Conaruct[onpermit
App ' ion is hereby de fo a permit tq�Construct (�J, Alter ( ), or Repair ( )an individual Well at:
- — — e ZL �/— -- ---
- -
—Locatio—Address Assessors aadP
/ 0 Address —
Installer - Driller Addre�
Type of Building
Dwelling----- — -- — ----------
Other - Type of Building-----------—- No. of Persons------------------------
� C aC ---- Ca acit ——
Type of Well—___— ----�---�— --- P Y-------/--------- -
. Purpose of Well----- -•�t
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 erti ' ate of a has been issued by the Board of Health.
Sign - -
t
Application Approved By -- -
-�
dat
Application Disapproved for the following sons: -----— - ---- - ---------
Q^ - date
Permit No. —JD% I --- Issued---(�- --- -- - ----
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
(Certificate ®f (Compliance
THIS IS TO-CERTiFY, That the Indivi4pal Well Constructed (G,<Altered ( ), or Repaired ( )
Installer
at 11P
has been installed in accordance with the provisions of the Town of Barnstable Boa of He It I vate Well Protection
Regulation as described in the application for Well Construction Permit No -----J ated--------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE---------------- --— - --- Inspector---- —-- - - -----—--------
-
',(/,,//h///iV /
V
eRX
No.-------�.---------- Fee—
BOARD OF HEALTH
jo TOWN OF BARNSTABLE
0i lication Ar Vell �Congtruct ion permit
P
App 'clion/ii-s�h by in die jfo j a permit t9lConstruct (41, Alter ( ), or Repair ( )an individual Well at:
- — — - - —6
Locati n�/. Address A---------i-
ssessors a a d P.ar 1
4 � Owner
Address
` Installer - Driller Addrei
Type of(Building
Dwelling
Other - Type of Building------------------- No. of P/ersons----------------------------------
I+ C/� IL/--- — -- - Capacity--- r
Type of Well P Y---— — — --
Purpose of Well----- �!�'''�"-'`'�`�" — -
-
i jj Agreement:
`The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
j Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place'the well in operation unt'l a Certi 'cate.of is has been issued by the Board of Health.
f G
l Sign d
Application Approved BywW/61,6, 10 sac
Application Disapproved for the following
ly date
Permit No. J �--- --- Issued---E�'— --�- ----------- -----
date
s
BOARD OF HEALTH
TOWN. ,OF BARNSTABLE
C Certificate Of ComPliance t
w THIS IS ERTIFY, Th .t�h Individ,al Well Constructed (vl, Altered ( ), or Repaired ( )
L/A Installer
/,
has been installed in accordance with the provisions of the Town of Barnstable Board of He It Private Well Protection
1
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------------------------------ -------
BOARD OF HEALTH - ----.---�.—.-,... - ---�-� - - -- --_•.�. I
i TOWN OF BARNSTABLE
IDell Con5truct ion Permit
-- Fee -----
No.
Permissions is hereby granted --- ------
to Construct (�, Alter ( ), o Repa' ( ) an I ivi ual Well at:
No. ——��--�-—�L 1,iM --—------ — --- - — - - - -
Street
j as showr
e appl�*cation f a?Dell Construction Permit
No.- (
---- Date --- — — —-- -----------------------
d
O
------- -----_._-
DATE Board of Health
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