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HomeMy WebLinkAbout0317 PLUM STREET - Health In �L SfAad, c,v . l3arXr. �c/ClS L 'I 7 / s- No.-------------------- Fee--------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Application-*r Vell CongtructionPermit Application is hereby made for a p rmit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: ---------21 /Cl/�7 SI ----- ---- ---- Location — Address Assessors Map and Parcel -------- Owner Address --------------f ' /.�.v lI__ �// ,D�°i/-- --------------------------��-----I----S_�a� Installer — Driller Address Type of Building n„� � Dwelling --NC,-- lJ -------------- Other - Type of Building---------------------------- No. of Persons-----------------------__-__ Type of Well——=-------- — --------- Capacity---- — ---——- —— ---— Purpose of Well---� �A ^— O114- -�1Cl3da%� 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 ertificat`e .off Com liance has been issued by the Board of Health. Signed - _� _ — /-o�1/_16191 _ date Application Approved By date Application Disapproved for the following reasons: ------------- - --- -------------------------------------------------- - date — 7 / -- Issued--- -- - - Permit No. --- - --------------- ---- ------ date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate ®f (Compliance THIS IS T�RTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) Installer 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. ----------____Dated----- ____ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE----------- -Inspector----------_--____-- --------=- Fee-------------- ---- B'OARb OF HEALTH TOWN OF:. BARNSTABLE Application'-A, rVelr CotWtruction3Permit Application is hereb .made for a p rmrt to Construct ( ) Alter ( ), or Repau ( )an individual Well at: .3 � /cir� s ------ -- - - =------- ---- 'Location Address:' Assessors Ma and'Parcel P f < -- - ----�.�r_---�i�!ESzL- ----- -------- ------- ---------��-�-,%ram s'�----------- Owner Address, F Installer — DrillerL Address i Type of Building il /� Dwelling — -- ------ -------- ' ----------- Other - Type of Building --- -------- No. of Persons------------- 1,, (( Type of Well---------- -- rt —' � 1 Capacity— Purpose of Well '�"-L= " g=©`'V'= —� �9,5► r e„ Agreement: The undersigned agrees to install.the aforedescribed lirloividual well.in accordance withs 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 Com liance has been issued by the Board of Health. Signed — date c Application Approved By --� -------- — ------- date. Application Disapproved. for the following reasons:----------------=-=------_—________—____—�-_ ---- -------- ----- --- 7 , ate --_ Permit No. --- — -= Issued --- = - - ---- --------------- y '14,date BOARD OF HEALTH TOWN OF �BARNSTABLE Certificate Of 'Compliance THHIS IS TO CERTIFY, That the.Individual Well Constructed ( ), Altered ( ),.or Repaired'( ) Installer r/ 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----- ____ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE,CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY: DATE ,aj1 ;x -------- - Inspector --- --- - --------- aemTcs Jlw�G±iTGlYNilpliwGlili4iliililii%!4 iT�4ilitJelitititit6lii4iliOi4ilL4Y�Si9i4;9i!iPi4MGQG4ilr6li!+ppni9i!!iMDd@iwG4wA'ii!G!lilP.rGli�}4±i'!a4Vai_i±e��±i!G'Pi±M6wO�i±iw i BOARD OF HEALTH TOWN OF BARNSTABLE Yell Con5truction3permit Fee- Permission is hereby granted to Construct (�, Alter ( ), or Repair ( ) an Individ a No. l ell at: /7 //41 i.- -------- --— --------------- - - - - - Street as shown on the application for a Well Construction Permit No.- Dated- - Z� . - --------- DATE-- _ Z - / Board of Health