HomeMy WebLinkAbout0375 CEDAR STREET - Health 375 CEDAR STREET
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TOWN OF BARNSTABLE
LOCATION - 375 Cedar-Street SEWAGE #
VILLAGE West Barnstable ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) 2-cesspools (size) 6X8
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BL BBR-OR OWNER Mr. Sampou
DATE PERMIT ISSUED: I n 1A A n n M Q C D o c �i
vvn n�r� !NO,
DATE .COMPLIANCE ISSUED: BOX 66
VARIANCE GRANTED: Yes 0ENTEBo ILLE,MA,02632
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No. ------ Fee--- ------------
BOARD OF HEALTH
TOWN OF BARNSTABLE kip
Zpplication for Well Cootructionjermit
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Application is hereby njade for a permit to Construct ), Alter ( ), or Repair ( )an individual Well at:
Location — Address Assessors Map and Parcel
O ner Adder
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 .of Compliance has been issued by the Board of Health.
Signed -- _� -1'_
date
Application Approved B
date/
Application Disapprov for the following reasons:
v0 Z-A ! — date
Permit No. ..._.t.l._-. ---- Issued----E--------� ----- --�
l Zo 1
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of Compliance
THIS IS TO R IFY, That the ndivid al Well Cons cted ), Altered ( ), or Repaired ( )
by
Installer
athas 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--------------------
;E -V
zo
S o�
No------------------ Fee----
BOARD OF
HEALTH
---_-=---------
TOWN OF BARNSTABLEf
} ZpplicationArVefr Conitruct ion Permit
VL D`xetr-
Application is hereby de for.ape !t to Construct ), Alter (' ), or Repair ( )an individual Well at:
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Location — Address / V —' Assessors Map and Parcel
O ner ---
Address
Installer — Driller
Address
Type of Building
Dwelling—--_--- _—--—--- --
f` 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.of Compliance has been issued by the Board of Health.
Signed — —_— __— _-ZAA_1.7-3 �/
date
Application Approved B �I /Z 'J
date
Application Disapprovzforhe following reasons: —.------------_—.___—___—_—__— _—___
1
3 date
Permit No. �� _ _— Issued--� --Z�--� -�-e_ ____—__ -------
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
(Certificate (Of Compliance
THIS IS TO VERIFY, That the Individual'Well Constructed ( ), Altered ( ), or Repaired ( )
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 No. ---------____Dated------ --------
f
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
Ivefl Con5truct ion Permit
No. Fee
Permission is hereby granted
I' to Construct ( ), Alter ( ), or Repair ( ) an Individual Well at:_ _
No. -- =r ,- --s—� —_--_----------------------------
street
as shown on the application for a Well Construction Permit ' .
No. C) 2 y' -- -- Dated- 2"3 - ------------------- -
/ oard of Health
DATE --
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