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HomeMy WebLinkAbout1161 RACE LANE - Health y r s , a t f i �`•' ro ✓1 +r,{:, #..Yam ro� _�..'k.d k!' , x „ a , 5 � �.,4 a' ... -Y �'.:'r b.. ra„ p' .Fl.a. I �tr' 11' •.�. t �:z 'L^>{, :,,,Pt .'G- .�."� 4a«,. ,i,. ,+ ,� ..rz a?x.• ..�'..., a �`ti. Y'i?,? FRS? tl. , �s�?'"�.c§ .,..,., s.. ,.•J.. ? ''... "r. �,•,..,:, '" �'• •� �; '.,yt a ..t? �,,'. ' •x _ _ .i'a r �Y�,l''iHdf r, a -:::�t '.!"P'>: "p::..:. `s.} < ".4.'I la:�" e 't '•b e�f`„- _ i^: _ 4 F Yz `�y.Gt: �' -.,. ".,fj +., a -.....: , .. _ f•a "j i A"Y , 'li At fe�, _ k� k a7 k1� ' .. ' a ,r min S RY f•i '� d \tf rt " T. 4 { •h � N - i} r S � Y: � ,• L .Y.". .1. .. Jet ,., - rw -' ..:,...y '' ., .i. :..' " .. •• ,: `�. ' .. '` 'k•' ' t ,, ,drtl-i. S ,., r,��. re:' •�',. "' i... 1 il-. " '��, � � '° ;"e. �t 4 5i � 4 '� P b �'r`, 9 �'� f v, r]x � S •r. .F t L I FS', Y l�. . ,4� a ?:.y ,.N a ,i , t• .� i 1 - •y e. ' „ , t - •,, . go-. � .� � '1 r .. t +¢. ! r. 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T , r�r > Y n y � .. .,.,. . a ,_ � S:, ♦ � t, . .. � _ e. :. • , •' - .. ii - .. a •. .. :tom K- , , r , w , n . .. k -. � •- L Y ',1. •. s yF .. , ''t `f• . - f. t � � tr4 � i. •J� `I y � .d• S r ,r t f t.� f a h A" µ . 3 , ok3 orC� 00 No.------------------- Fee----------------�_ BOARD OF HEALTH TOWN OF BARNSTABLE 0[pplicationArVell Con5tructionPermit Application is ereby made for a permit to Construct (-I, Alter ( ), or jtF air )an individual Well at: - �1 , /- - - - --- )- Location _- Address _ Assessors Map and Parcel -�'�,ru�L-Fix_+.i.c-���----------------------------------------- �-'�fi�-`�-�'----� � �G�� Owner Address Installer - Driller Address Type of Building Dwelling----------------------------------------------------------- Other - Type of Building------------—------------------ No. of Persons----------------------- Type of Well— ��-- -- —---- - ------- - Capacity-----------------— —— —- — --— _--— 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 Compl' nce has been issued by the Board of Health. Signed date -7s Application Approved By— - --------------------- ------ date Application Disapproved for the following reasons:---------------------------------------------------------------------- ------------------ -- — --- ------ -------------------------- ----- nn (f date Permit No. --- �L = v__�--_ — - Issued--- —�-�� - --- - --- --------------------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS,A TOE� CERTIFY, That the Individual Well Constructed (."), Altered ( ), or Repaired ( ) by-�(1__T_J_Lt -� �� - - - — ----------------------------- ----------------------------------------------------------- /� / Installer /I ZLe^,.�/' �V O Co CcL c. /N /Lt G JS �.�5 �t-t f_s------------------------------------------------------------ a t- ----------— _---— --- —- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Pr tecti n 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-- - —------------------------—--- ----— ©o No.-------------------- Fee----------------- --- BOARD OF HEALTH TOWN OF BARNSTABLE ApplicationiforlVe[C CongtructionPermit Application is`Pereby made for a permit to f/Construct (✓), Alter ( ), or Repair ( .)an individual Well at: Location — Address Assessors Map and Parcel ------------------------------------ ---------------------------------------------------- Owner Address - ------------------ 3/ /J"' Do,L- ��1 vS(. Installer — Driller Address Type of Building Dwelling--------------------------------------------------------- Other - Type of Building---------------------------------- No. of Persons---------------------------------------- Type of Well-Y r--------------------------------------- Capacity---------------------------- ----------------------------- Purpose of Well-!-/,66�/,-,. - 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 � —------ Application Approved By �="�—'"----------------------- ---- �_------- date Application Disapproved for the following reasons:--------------------------------------------------------------- -------------------- ---- -- -------- ------------------------ ---------- --------- - ------------ ----- date n V Permit No. ----�-v--r'�-- ---- Issued--- - � - --- ----- date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate ®f (Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ("), Altered-( ), or Repaired --- bS —'�' --- - - -- ------- --- --- -- - -- - ---- - / Installer at-- G M '— U Gc L E L-nJ /Lt!y �� c3.v S `A --Z------------------------------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Pr tecti n Regulation as described in the application for Well Construction Permit No. -I-f''---yv Dated THE i 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 BARNSTABLE '1 U)ell Con0ruct ion Permit No. -----------'--- Fee-- -------- Permission is hereby granted -�--�`—"''` w` r/ ��' ' to Construct ( ),''nnAlter ( )�,/�or Repair ( ) an Individual Well at. No. ------------------------------------------------ Street as shown on the application for a Well Construction Permit No. -----------r��- ten_ -- ---- - -- - - Dated --------------------------------- - � u ------------------- �._ - Board of Health DATE-------?---,���- ---