HomeMy WebLinkAbout0191 FLINT STREET - Health / . � 12-q
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No.-��/-- �1~'�� Fee -----
BOARD OF HEALTH
TOWN OF BARNSTABLE
'applitation;ftrVefr Con5trutt ion Permit
Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an in ividual ell-at:
Location —/Address Assessors Map and Parcel /
Owner �— _ — Address p 7 6
-D_A
Installer — Driller } Address
Type of Building
Dwelling--------------------------------------------------------
Other - Type of Building------------------------------ No. of Persons-----------------------------------------
--------- Ca acit
Type of Well-----y----�:�'____------------------------- P Y------------------------------------------___---------------------
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 o Complian a has been issued by the Board of Health.
Signed
--
date
Application Approved By"`� � '— "=- ----__ ______________ �� "date
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Application Disapproved for the following reasons:----------------- --------------- -----_______—___._____�______________
-
--------------------—--
date
Permit No.- -�'6/' r- - ----- — Issued - -�----
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of Compliance
THIS IS TO CERTIFY, That the Individual Well ConstructedJ4 Altered ( ), or Repaired ( )
Y——
Installer
at--------- �!1.1 _-------------------------------------------------------- -- -------- - ----
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-a=el"-'---r-' 1
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE--------------------------------—----------------------------- --------------- Inspector—-----------—------------------ -- --—-----------------------
No.-lye- `----= � Fee—'�"--"r`-- -----
BOARD OF HEALTH i
_ f
TOWN OF BARNSTABLE
Zippl4ation-forlDPYr Coot crionpermit
Application/%�hereby made.for a permit le C/ stkruct ( ),�Alte�S J, or R ja �(�i)an inc�i�dqual 1 0l�L - �•-_ _�I
Location — Address Assessors Map anld_Parcel T
- J=�-r------C -ef-- ---� �y� - — - ----- ---- T.
l r�/`-----SQ u C,
Owner -- - Address 0.7 c 2.)
aCu/v.. C�� C OJ �r'r is v l p ./JJ C?
----(J- -- -- — -" — L----1- ----- — — —
Installer — Driller Address
Type of Building
Dwelling-----------------------------------------------------------------
---Other T-ype of Building--------------------------------- No. of
- - Persons-------------------------------------------------------
Type of Well-- 4/ —-------------------------- ------- CapacitY-------
--.'r
-------------------------------=--------------------------------------
Purpose of Well---LK--CGw —--------------------
Agreement: a
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The undersigned agrees to install the aforedescribed individual well in acc rdance 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 Complian a has been issued by the Board of Health.
r
Signed-•)—z
1 r l date /
- ------ ------------ - - '- -
Application Approved By-- -��
date
Application Disapproved for the following reasons:------ _ - ------------------------------------------------------
- ----- ----- -=------- ------------ aa e
t ,
Permit No. --------------- Issued -------- -Ar-7p
- ` ---------- I --
s' I date -------------}
r BOARD OF HEALTH
TOWN- OF BARNSTA LE
Ct Iatifirate ®f (Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed W), Altered ( ), or Repaired) ,!
--- _ -f' , � - -------------------------------• Installer
^^ 1
at----------f 51 ---- Tom' - — - ------------------------------------ -- ----------------------------------
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has been installed in accordance with the provisions of the Town of Barnstable Boar of Health Private Well Protection
/
Regulation as described in the application for Well Construction Permit No. � --= -----`-=.---� ated--p--="'--�--�-----
THE ISSUANCE OF THIS CERTIFICATE SHAD.);,NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY. ,3 Q I
DATE------------------------------------------—----------------- -Q- Inspector--------------------------------------------------------------------------------
� t �1
BOARD OF HEALTH �!
TOWN OF BARNSTABLE I
Very Con5truct ion Permit
No.-------------------- J Fee------ ------------
o�
Permission is hereby granted------- 19_1 � - Y_ 1� �•� '
to Construct ( (i); Alt e ( ), or Repair ( ) an Individual Well at-.� `
No. -- T� � -- --------------------------------- ---------------- - ---------------------------------;-------
Street
as shown on the application for a Well Construction Permit
No.------------ '"` '" ' 'r------------------------------ Dated ------ -------� -----------------------------------------
-�,��-'-tea---� ------------- -----
Bo'rd Pof H
DATE-------- -fir---- -r --------------------- f
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