HomeMy WebLinkAbout0383 WHEELER ROAD - Health 282 W heeler Road -
Mars Mills
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UPC 12934
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BOARD OF HEALTH
TOWN OF BARNSTABLE
Appricat ion ArVeii (Con0ruct ion Permit
Application is hereby, made for a permit to Construct ( ), Alter ( ), or Re air (man individual Well at:
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{ Location — Address r Assessors Map and Parcel
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—/Own/eer — q Address
� ASd4. i�+ (.v�.G'(lE/,.YL�, /-./�®.� a f*,-,
Installer — Driller Address -- _ —
Type of Building
Dwelling
Other - Type of Building - No. of Persons-- -----------_—.--______
YP g-_�__�._____
Type of Well Ll �u t 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 Certificabe Af Compliance has been issued by the Board of Health.
Signed Z
�-- ` );Ie
Application Approved By—Q � — --—— 2- _—
date
Application Disapproved for the following reasons: ----- ---- --
date
Permit No. OU;L _57 — Issued U Z - --------- ----____— date
BOARD OF HEALTH
TOWN OF BARNSTABLE
(tertificate ®f (tompliance
THIS IS TO CERTIFY That the Individual Well Constructed ( ), Altered ( ), or Repaired (4-}
------------------------- ------- ---
Y— Installer
at_-3 Q to e le/ �d --- — -- -----------
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. 00� 6 Dated—ZIMA-?--
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE---- Inspector--------- --------- ------
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1 p ,
No. ----------- Fee-------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
0(ppIicat ion-*r Well,Con5truct ion Permit
Application is hereb made for a permit to Construct (';,0 'Alter ( ) or Re air (�an individual Well at:
Location — Address Assessors Map and Parcel
Owner — Address --
Installer — Driller Address
Type of Building
Dwelling --
Other - Type of Building-- -- No. of Persons-- ------------_----___
Type of Well �� �`' C — Capacity-----------
Purpose of Well
00
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 Certific a.of ompliance has been issued by the Board of Health.
Signed c L----
,� p date
> � P` 2-
Application Approved By .. --____ —__
j date
Application Disapproved for the following reasons:
> _--__.__ --------------------- date —_
Permit No. V UU;t 57 Issued G 2-
� �� ------date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of Compliance ,
THIS IS TO CER IF;, That the Individual Well Constructed ( ), Altered ( ), or Repaired (`-)
by —�H
/� Insfa��
V-
at—
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. W-� ° - Dated� �� 'G 3---
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
Well Con5truct ion Permit
No. Fee—C/S
Permission is hereby granted ----
to Construct ( ), Alter ( ), or Rep it ( ) an Ind dua-1ANelI at
street
as shown on the application for a Well Construction Permit
No.- a U�1,? - . Dated— -------------------
—— 14 = -- - -
---DATE Board of Health
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