HomeMy WebLinkAbout1174 PITCHER'S WAY - Health 1174 PITCHERS WAY ,
HYANNIS
A= 273 - 123
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y
No. V" Fee vl�
BOARD OF HEALTH
TOWN OF BARNSTABLE
01ppYicatiou jf or l Vell C InMruction J)ermit
Application is hereby made for a permit to Construct( ) Alter( ), or Repair( ) an 'individual well at:
I( -Address ssessors Map and Parcel
r/ S n_E L Mj4k PuA wis l
Owne Address T ozc,4/
Installer-Dr'le Address
Type of Building
Dwelling
Other-Type of Building !� e No. of Persons
Type of Well a y 1 c, Q,{-i rjY1 Capacity
Purpose of Well 1 y✓ram �,, C 0 to
Agreement:
The undersigned agrees to install the afore described individual well in accordance with the provisions of the
Town of Barnstable Board of Health Private Well Protectio egulation-The undersigned further agrees not to place the
well in operation until a Certificate of o I ha a issued by the Board of Health.
Signed
J ate
Application Approved By I
Date
Application Disapproved for the following reasons:
II-- Date
Permit No. � Z� "'��P Issued
Date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of Compliance
THIS IS TO CERTIFY,that the individual well Constructed .1tered( ), or Repaired( )
by ✓
Installer
at // 7q Fj I c A.e
has been installed in accordance with the provisions of the Town of]Era rnsta a 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 SATISFACTORILY.
4
Date Inspector
r ;
r No. +�"vvZ( � V� Fee
w �
BOARD OF HEALTH
TOWN OF BARNSTABLE . r
1
0(ppYication jf or Yell �tC n5truction i3ermit
Application is hereby made for ermit to Construct Alter or Repair( an individual}well at:
PP Y {P �� ( ) P ( )j �...
I 12 Ll R .e vS k/A V
Location-Address 1ssessors Map and Parcel+;
Owner Address 4. d/
Installer'-Drille%r r Address
l
Type of Building
Dwelling }
- T ype of Buildin'�`. eft c cs �
Other=T g No. of Persons
Type of Well ` '1 1 v ► c, cjt or) Capacity r A A
Purpose of Well i V,✓,•fey C-, , 1_1
Agreement: {
The undersigned agrees to install the afore described individual well in accordance with the provisions of the
Town of Barnstable Board of Health Private Well Protection
a 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
g _
✓ v �J� Date
Application Approved Byi;/
(,,—�•� Date
Application Disapproved for the following reasons:
<. Date
Permit No. �y �.{ 'iL`� - Issued y t i ; Z _
�: ... Date
(( a S .
' BOARD OF HEALTH
TOWN OF BARNSTABLE
i ,
Certiftcate of Comp'liance
THIS IS TO CERTIFY,that the individual wells Constructed(v), (filtered( ), or Repaired( )
by
t Installer
at // 7q ! , IGA-e� c lf)4l
has been installed in accordance with the provisions of the Town of Barnsiaie 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 SATISFACTORILY.
>Date { J Inspector
., P
----------------------------------------------- -®_b___adoda>_vmmes. -----------------ae_vo>vee
BOARD OF HEALTH
TOWN OF BARNSTABLE
1A r Vern Con.5truction joermit F
No. V Fee vl
�rPermission is hereby granted to �-' V V'Q i '
Installer
to Construct(L),, - Alter( ), or Repair( /an individual well at:
� I
No. iL..f 1 C�✓. �C� .�
Street
as shown on the application for a Well Construction Permit No. j Dated-
(
Date Approved By `