HomeMy WebLinkAbout1541 MAIN STREET (COTUIT) - Health (2) �, � _..,
d 1`7 � �
- -- C
No. w Fee "l J
BOARD OF HEALTH
TOWN OF BARNSTABLE
Z(ppYication -for Vern Con6truction permit
Application is hereby made for a permit to Construct(X), Alter( ), or Repair( ) an individual well at:
15 y I K6 h St , C01-B t j 'O l d 100 7
Location-Address Assessors Map and Parcel
NFU 12cc, eta r.Sl� f4A[fi l L AC W In !,I+(D+j�} W 52(:735
Owner Address
4 I1r [ c . Po 66K wg'-3, orIergh5, �I—ez���
Installer-Driller Address
Type of Building
Dwelling
Other-Type of Building No. of Persons
Type of Well y &61+L[D T V L Capacity
Purpose of Well 1 jC V 10 CLff6-"Y1
Agreement:
The undersigned agrees to install the afore described 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 Cer c to off'Complia ce has been issued by the Board of Health.
Signed
Date
Application Approved By (( 22-
bate
Application Disapproved for the following reasons:
Date
Permit No. � b Issued l ( ( �—
Date
--------------------------------------------------------------------------------------------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of Compliance
THIS IS TO CERTIFY,that the individual well Constructed()0, Altered( ), or Repaired( )
by D I l I Ty,[l I�1 c- - Installer
at �rJ� 1 h— (,O lU l�-
has been installed in accordan a with the provisions of the Town of Barnstable Board of Health Private Well Projection
Regulation as described in the application for Well Construction Permit No. Dated ?lZ
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORILY.
Date Inspector
I1�12 b?i Z Fee
No.
ZX BOARD OF HEALTH a.
ry . , TOWN OF BARNSTABLE
Yicactiou for DerrCoi�5tr fiction errrYit
Application Is,hereby made for a permit to Construct(�O, Alter( ), or Repair O an 'individual well at
1.5 N•I I\IILt i 14' , C ?�i,l i Ci {-1 00
Location-Address Assessors Map and Parcel
f.LC 1 (y) A (P)47id AIA* �2G-3-9
Owner J Address
1 'Irn 1a1 I 1110 //j ITV_ PO SAX, u7g3, 0" Imijc NA- a-2c^ �-2
_ l J • _
Installer-Driller Address
Type of Building
Dwelling
Other-Type of Building v 6 V-CC h 11 a Uez No. of Persons
Type of Well ( �/�. Capacity
Purpose of Well I V I/ I(A C1 h 6)6
Agreement:
The undersigned agrees to install the afore described 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 Compliance has been issued by the Board of Health.
Rr Signed
U Date
Application Approved By
r / Date
Application Disapproved for the following reasons:
Date
Permit No. { �, TL U Issued
( / Date
+ BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of Compliance
THIS IS TO CERTIFY,that the individual well Constructed(y), Altered( ), or Repaired(
by
J Installer
at I1�l1 1 L1 (A-)
t has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection t
Regulation as described in the application for Well Construction Permit No. iJ�iiC�'�� U1 Dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORILY.
Date Inspector
BOARD OF HEALTH
TOWN OF BARNSTABLE
Yell cow5tructiou J)ermit
No. �/V+` 2- `��O Fee
Permission is hereby granted to
JInstaller
t0 \�Construct( ', Alter(`), or Repair O an individual well at:
K -
No. C7 L{ I NA fi1 —
' Street
as shown on the application for a Well Construction Permit No. I i i/ 'V�D Dated
Date V} I"t f Z-- Approved By r�
f (
I
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PROP. 144'X 21'
ti°GREE!1460USE,�
(FFF�120.6)
6" PEI�ORATED IN / `, INV.116.8pi
(BOTti SIDES
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RAIN/GARDEN �- -
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r 122 x� , - � 1 \ �� I I , ► i
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