HomeMy WebLinkAbout0868 OAK STREET (CENT./W.BARN) - Health 868 Oak S,+_:eet
W. P ri'�sCable
A = 216 005
I
d
- 05
No. ------- Fee-
BOARD OF HEALTH
TOWN OF BARNSTABLE
Zipplicat ion for Vell Con0ruct ion Permit
Application is hereby made four a permit t o t cct (l), Alter ( ), or Repair ( )an individual Well at:
Location — Address Assessors Map and Parcel
Owner _ Addres —
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 Af Compliance has been issued by the Board of Health.
Signed
Application Approved By -- Ges /daa
date
Application Disapproved for the following rea ns: -------- --------- ------ --
date
Permit No. Issued �v-(�
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of 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 Bo'a)rdd of He�altth� rivate Well Protection
Regulation as described in the application for Well Construction Permit N1&W: '_' ated-----THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE-- - — Inspector--------------- ----_ —__
0�41 A �J
No. -----------
Fee'---- ----
BOARD OF HEALTH
TOWN OF BARNSTABLE C
t Applicat ion for lVPrY Con4truction l PrTntt j
Applicati is hereby made for permit tjo t ct (/), Alter ( ), or Repair ( )an individual Well at:
Location — Address Assessors Map and Parcel
Owner r — Address
---- -- -- ------------
Installer — Driller Address --
Type of Build'g
-
v
Other - Type of Building----- ------ No. of Persons--- _ `---� —_
T e of Well ��4A&r 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 C rtificate .of Compliance has been issued by the Board of Health.
Signed --�- �--
+; ty
�G// � date
Application Approved By '��
t
% date
Application Disapproved for the following reas6ns: — ------ ---- --
1
f — ���— —�---- date
Permit No. �:�----�-- _ Issued-- —�-r =----------
! dateA
BOARD OF HEALTH
TOWN OF BARNSTABLE
C ertif icatr ®f Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed (/), Altered { ), or Repaired
r 60
i:• I 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 ated---- -------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE - Inspector------------- ----- -- ----
r.��.r—,�. �_ —.—tom.—.����T--a•--..�� ��—.... ..s._. a�r..;�-r T:r_.�—a..j.r.-.—..c,m�r�rn ems.�—s��.m..��. s..�:.a�
BOARD OF HEALTH
TOWN OF BARNSTABLE
IvPCY Con5truct ion Permit
.�A /�
No V Fee- ----
Permission is hereby granted' � -----
to Constru� ), Alter ( ), or Repair ( ) an Individual Well at:
No. r�lo .ate ,S _ /i1. elateiv -
- street /•
f as shown o1nJ the application for a W ll Construction Permit 11
f P r am% /0 �3/No.--=�-- ��� � Dated -------------------------
— t
�' 'Bard of.Health -�`
DATE o
� �•-��----�-�— .. —_ �. ^ s`+ .
4 a-(:;
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I
AsBuilt Page 1 of 1
LOCATION SEWAGE PERMIT NO.
VILLAGE
I N S T A LLER'S NAME i ADDRESS
Q __ !\=k uzjaA, /ak C a.'Ia ci — /d o p S
BUILDER' OR OWNER
DA T E P ERMIT ISSU E D
r
DATE COMPLIANCE ISSUED
t
0
http://issgl2/intranet/Propdata/prebuilt.aspx?mappar=216005&seq=1 5/15/2014