Loading...
HomeMy WebLinkAbout2928 FALMOUTH ROAD/RTE 28 - Health R& C>2-d- t I i No. - -=— (j Fee--.eS-----2------ BOARD OF HEALTH TOWN OF BARNSTABLE zipplirat ion-for lVerr Cou!gtrurtionPermit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: --'ZS ---- -- ---------- - - �-''O ZLD -- Location — Ad ess Assessors Map and Parcel —rl'-` �°—'`�FJr'S - `�S _ r4��n� 5 {&oAyl- 4 Owner Address ---D i L--� Installer — Driller Address Type of Building t t Dwelling -- Other - Type of Building No. of Persons---- Typeof Well------_--------------------------------------------- Capacity-------------------------____________.—_�—__-------------- Purpose of Well Zzfu6-4-n 0�- --- -- 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 mpliance has been issued by the Board of Health. .C7,e,.�•� � 1l J s e Signed_-______-___------------------------_-_---------___-____ —�---�---Y------ date Application Approved By---- ate Application Disapproved for the following reasons:------- - -----------------------------------------------------------------------------------------------------------------------____—__-------- date " Permit No. - - - - '=- ----------—- Issued —- -- - ---- date BOARD OF HEALTH TOWN OF BARNSTABLE Certifirate Of Compliance THIS IS TO CE TIFY, Tha$ the Individual Well Constructed Altered ( ), or Repaired ( ) D./ cct�,.�_ _- ------------------------ ------------------------------- Installer at- a � -- 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-- -- - -- - — ----------------------------- Fee---- --------- BOARD OF HEALTH -TOWN OF BARNSTABLE Application_*rVell Con!6truction3pr mit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: 212_�- -?T---Z'? --------------------------------------------- Location -----�{�_�_-�`©��� -------------- ------------------------------------ - Address.' � Assessors Ma and Parcel _A 1.,zs,ki �7_EM?q&' j 4Hoorys, _FI_F+4L�M01SIT 4 -141(,H wA-Y-. -E,-TA_v_Lkoo-CA �,Owner'� Address 2 Box Installer — Driller Address _ Type of Building � t � :.:-' �'�'•"- j f+,: Dwelling I---OC�1 = COV— -x 1 �•�, + _ s .. ;�, :. r r \ Other - Type of Building !SZE--F-'>--K e)-�`-�- '., No. of,Persons----- Type of Capacity_-------------------------------� Purpose of Well-- RiZ16$1_n ?til------------------------------ r 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 —----- ..a date '" - Application Approved By-----� � - --'� —/--date Application Disapproved for the following reasons:----------------------------------------------------------------------- - - - ---------------------------------------- date Permit No.-------- �' l -- - Issued - -- — - ------------------ —- r-------�" —— — date BOARD-,PF-,HEALTH, r f TOWN OF �BARNSTABLE (Certificate ®f (Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( �), Altered ( ), or Repaired ( ) by--- ---------------------------------------------------------------------------------------------------------------------------- Installer 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 Noeq u------'-- --Dated-------------------------- t 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-'� RARNSTABLE Yell Con6tructioupefmit NoAkI C�C-/=-lo- Fee- Permission is hereby granted-! - � --!--/------- to Construct Alter ( ), or Repair ( ) an Individual Well at: No. 5 �cl--/?T-__ 2 ------------------------------------------------------------- -------------------------- Street as shown on the application for a Well Construction Permit No. �LJ -- = - ------------------------------- Dated----------42!` _- - ---------------------- ` q^� Board of Health DATE--------- <t� = ------------------ r ,