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HomeMy WebLinkAbout0104 GREAT MARSH ROAD - Health LTL 0 REAT MARSH RD, W. BARN. A= l dD'5—OoL' a Omrford. NO. 1521/3 BLU No.U11� _� Fee f j ----------- BOARD OF HEALTH TOWN OF BARNSTABLE 1 ApplicationArVei[ Con0ructionPermit Application is hereby m de for a permit to Construct (/-11, Alter ( ), or Repair ( )an individual Well at: OBLO0-�-o 0 y °--- e Location — Address Assessors Map and Parcel ------------------------- t�/ er �/� �Q y -Address `cam.:✓ G T U Installer — Driller Address Type of Building Dwelling ------------------------------------------------ Other - Type of Building--------------------------- No. of Persons-------------------------------------- Type of Well J` h 40 >0Urs '� / 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 ertificate .of ompliance has been issued by the Board of Health. Signed —------ `2&�--- date Application Approved By — -----—— Q)____ Ate Application Disapproved for the following reasons: ----------------—------ —_______—__—_ —_ / j date Permit No.1tv_ b� -_�� __ Issued------------- / --- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TQ C�ERTIFY, Th t the Individ al Well Constructed ( ,� Altered ( ), or Repaired ( ) bY— -( �J'✓T�hd_ "lc- iG Grp-tom___ ----— -- - — // Installer has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protectio Regulation as described in the application for Well Construction Permit No.1J-J l _ atedTHE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---- - Inspector---------------------- - —__ No.-- --------------- Fee--------------------- _ • BOARD..OF HEALTH r TOWN , OF BARNSTABLE �` Cication. orelr Congtruftonermt Application"is.hereby made or a permit`to'ConstrucY(I/1,'Alter (' ); or'Repair ( .:)an individual,We11 at: / Location t_ •Address - r Assessors Map and Parcel /�z �rn,rrk, n �)°l1 a, 4 /JT � p tier Address Z 6 66 ye 3 6J4 L��1 At_s (»/,Z Installer Driller — Address Type of Building ' i Dwelling -— -- - ---------- C Other, - Type of Building---- -------------- No. of Persons------------ ------ Type of Well Capacity: --=— --- yP .Jch �d. r?✓c.9 _— � j 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 ompliance has been issued by.the-Board of Health. Signed -------- --=���-=- p[p date r Application Approved By' /W�C.r.i�, �1C.�ta�..CX.0----——— . �' `�� ��— fto Application Disapproved for the following reasons:—==------ ------�---- ----___--_-_�___—. -- date Permit No. date 4�46titr�'d911i'!i>lrS�4rlr4�dile2vl�!$1b11!oRF.ri9Y,`iSai!a+P ..ip3!iEgtr4bfr@iliriliS�iVi J3li9E11tiW4iRiWti!1fi'Vp'yiSTbfitiSi>N9.'Y1348Q347 RiTT1liilii�^:ii'Adwsayl+YMuRfi,Pti9�'1'94ido9i4oTi'S.i ISMd+Ae+Ov+ BOARD OF HEALTH TOWN OF BARNSTAB.LE Certificate Of Compliance THIS IS TO CERTIFY, That he Individ al Well Constructed ( ,•Y, Altered ( ) or Repaired (.., )' Installer at 1-fa has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. 1=`©�ated—2 � - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED.AS A;GUARANTEE THAT THE WELL SYSTEM WILL.FUNCTION-SATISFACTORY. DATE------ - --. Inspector-------=- ---- -- j]!iiR•4s3s?s4lTvlti4i7s Ti►a+4�i��nir�we"'64i;!ii4ifdlis/bt4�+w!offs!6182►laPi1016la4itaN4l��1sETitlsle'tlts184�4r�Y`><446?XfpAi$d2rld}wilP!i'uw.i+.ix,ssla•s4as»a.+iTw!svivssiva'*3?era�..�..se *' BOARD OF HEALTH TOWN OF .. BARNSTABLE Vell Con5tructionpernitt � No. - -2��'6)J Fee .- Perms ��"c-_—__Permission is hereby- granted, — to Construct ( ✓j, Alter (: -) or Repair (.` ) an Individual Well at: Street as shown on the application,for.a Well Construction Permit J No.-W � �� 1 Dated - ---/ --- Board of Health - - DATE I