HomeMy WebLinkAbout1825 MAIN ST./RTE 6A(W.BARN.) - Health g ^ ' sf ate 6s GtJ • _
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No.J —------ - Fee- -= ---
BOARD OF HEALTH
TOWN OF BARNSTABLE
ZppYication-*rWell Con5truct ion 3permit
Application is hereby made for a permit to Cons ruct ), Alter ), or Repair (-✓jj individual Well at:
---------- -------- ---------- ----------- ------
Location — Address Assessors Map and Parcel
we_7~Z ---____-_ !�r�_ Mct;.�_s 7—/�?� I_
-s------- ----
Owner Address _
-S�c�,Ne1- - ------ -- --- -- ---------------
Installer — Driller — Address
Type of Building
Dwelling /4�o u S ------------------------------------
Other - Type of Building No. of
Type of Well---0 --5 7 /-- --------------- - — Capacity------------------— --
Purpose of Well-�d•`e -------------------- __________---
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 Compli a has been issued by the Board of Health.
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Signed� L ------- —a
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Application Approved By -- --vy da�0
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da
Application Disapproved for the following reasons:-------- -- -- ---- ------
------------ date --
Permit No. Issued---------- _ ________-------
ate
BOARD OF HEALTH
TOWN OF , BARNSTABLE
Certificate ®f Compliance
THIS IS TO CERTIFY, 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. 1'L R40-:!141 Dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY..
DATE------- - — - — —--- - -— - -- — Inspector
Fee. '-^ '_`�- ---
_ BOARD OF HEALTH
TOWN OF BARNSTAB LE
01pplication,jorlVell Congtructi I nVermit
Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (44in individual Well at:
ma N s T- vft G A 't� . t , �-{---- �Cr r
' E
-:- ----------------------------------------- ------ - -
Location — Address Assessors'Map and Parcel
Czic � JG!7.Z --- -- _� �� _i_ I T �� GA k GJ' NG�..3�4
Owner <rAddress
Installer — Driller '? �ddress
D) Type of B ilding ,,/I0 U 3
P A f
D ellin - - -- - --- - - '
17
O her - Type of Building-- -- - ----------------- No. of Person---- — ---------------------------
r -S G
-- S T c e --- -----—_--
. Type.of VYell----- ---------�_____------ ---------------- Capacity-�-------- ------------------
Purpose of Well
Agreemen : ¢ ~
The undersigned agrees to install the iforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation — The u do ersigned ful ther agrees not to
place the lell in operation until a Certific to of Complia ae has been issued by t<e Board of Health.
I4 date
Application Approved B .,r*,�
date
Application Disapproved for the following reasons:-------------------------`------------- "
- ---------
------------------- ------— �_— - --- --— -
-------------------------------------------------- date
07 Permit No.-- -'�""� -�'= -f�-w------------------\� Issued—- --�!_ 1 _--- — — --
date
BOARD OF HE I- H n
TOWN OF BAN-STABLE
ert�If ICa-te-�f�Oul. �IanLe
THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altere j ( ), or Repaired ( '`)
by-------!� _- �'� � �� W �� . Dr=� ! -- ------ - ------------------------
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 N 1. A''- ''�` -Dated
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
Ivell cootrurt ion Permit
No. Fee
Permission is hereby granted---------lilt' '5 A-91A1 ------IAklf4L---------Qf sk_o--------------------------------
to Construct ( ), Alter ( ), or Repair ( an Individual Well at: /f Zs MR�Iv
No. - y �" — ----�.�-o� -r— -- --- --- - — —
Street
as shown on the application for a Well Construction Permit
No.- - if/•- � ''�--''�^1�—-----------— - -- -- Dated--
> Board of Health
DATE-------- � "= -----
Pou S P-
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