HomeMy WebLinkAbout0091 GREAT MARSH ROAD - Health '91GREAT MARSH RD, W. BARN.
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No, �--- --- Fee-------------
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BOARD OF HEALTH
TOWN OF BARNSTABLE
2pplication Ar Well Con5tructionPermit
Application is hereby made for a permit to Construct ( Alter ( ), or Repair ( )an individual Well a##:
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— --- - -----2 -," ----------- _-----
Location — Ad s Assessors Mapand PareI
®e.4�"I�(�1LQ�t�. -_ ---�--" CO�.0 T® �`�� ---------O�SE�/✓��s /�/f9�!�La
O ner Address
-----� - —
Installer — Driller Address
Type of Building Ll---
Dwelling----------------------------------------------------------
Other - Type of Building-------------------------- No. of Persons-------------------
Type of Well---�-_- ---y0-10W�------- Capacity----1_�'�'1" —
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 Certificate .o)Tompliance has been issued by the Board of Health.
Signed -- ----- --- -- �- �—
At
e
Application Approved By � -e-�^ ��� �------— _ a ��--
date
Application Disapproved for the following reasons:----------------------------------------- ---
------ -- -
------------—-
date
Permit No. Z(D 4 r D -_ Issued--- -- --o)"f -
date u
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of Compliance
THI S TO CERTIFY, Tha the Individual Well Construct ( -°')'Altered ( ), or Repaired ( . )
by --=D — � —-------- - ----- — —
/�� /�nstaller //
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.k-? b PDated a 1_-
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE--- Inspector------------_— —_ —___
Z I-"O� y
No r` Fee-- ------------=----
BOARD OF HEALTH
' ' TOWN-OF. BARNS'TABLE
[irati6nforVell Cootruct on ermit
Application'is'here,y made for permit to Construct ( -) Alter'( ) or Repair.( )an individual Well al:
—Vol/ �_D_Z_ -.Yt�•s� �..
Location Address t — Assessors Map and Parcel '.
O'ner Address
�
Installer —Driller Address
Type of Building ''
r Dwelling - '—= ---= ------ -=- ------
} Other-'Type,of,Building--- -- — No.. of
Type of Well---- _ -___ Capacity---— - - -— �-- —
Purpose of Well =!.�'S� j ' --—--=-- . .
Agreement:
The undersigned `agrees.to.install the..aforedescribed individual well in accordance with the provisions of The i
Town of Barnstable Board of'Health Private Well Protection Regulation - The undersigned.furtheragrees not to
place the well in operation until Certificate.o Compliance has been issued by the.Board,of Health.
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Signed
date
C1Application Approved B /
o I
date _
jApplication Disapproved for.the following reasons: — ----------------- 1
------- _ — ------ -- — —,-----date --
I Permit No.- 7 U �U -_ : 'Issued=-- d
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�. ate
Y�Tititify7�!Ii'i,!W��i.1Sle9iti�it9i�(s!i'4gRO�i!4i?LLY lu4elo{� ! tel�RilSl8s6litittOfiM4i9iTi46Li�.fl4d11➢7!p�4iEi4i9b9i1i!4Yr4d:hlgRi?fili?albQY+tG464e1QF�9ATiw�4i}isy�54iTl4isi4:�M4i�i!4
BOARD OF HEALTH a..
TOWN OF BARNSTABLE
Certif Cate Of Compliance
THIS..IS TO CERTIFY at the'-Individual Well Construct dl( Altered ( ), or Repaired
by
/'' f, nsta
at - n -- --- ------- --
has-been installed is accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
- 7CD_1 15 oZ /S O
Regulation as described in the application for Well Construction Permit No. ----------= -wDated--1�-------
THE ISSUANCE`OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE-THAT THE WELL
.SYSTEM WILL FUNCTION SATISFACTORY.
DATE=---=--- - — Inspector----- -
3 4' 4arii�ceyRyylY4+lRiSas7• ry. y�i'b PYTil.'1i 1q9 .iii !it`Tilbin4`64'e -Mae;eili!>i�dRb! !,'�snY«^a.¢em�m�azrogz.,¢se..fa!-9a Pal�vr E a
BOARD OF HEALTH`
TOWN OF BARNSTABLE
'. Well C ngtruction o j3ermit
No. �zwm (.4. ( Fee
F / --_ Permission is hereby granted� — 7 --------
Noat-
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to Construct (✓), Alter ( ),. or Repair ( ) an Indivi Well /
Street
as shown on the application fora Well Construction Permit
qj i
No._ — (� Dated d�---------------------------
DATE 1 _ _- — Board of Health- - - -
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