HomeMy WebLinkAbout0317 MAIN ST./RTE 6A(W.BARN.) - Health 317 wrz�
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5 M EAD
No.2-153LOR
UPC 12534
smead.aom • Made in USA
CMSOUKMWOXWJMM
169tl�NMSiY000CTIlE
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CER71i1ED
SOURCJNG VN�MI.SFiR06RAMORfi
N,•- 7Z._(�� Fee /
BOARD OF HEALTH
TOWN OF BARNSTABLE
01ppYicattou jFor Vern Con5tructiou Permit
Application is hereby made for a permit to Construct, Alter( ), or Repair( ) an individual well at:
Location-Address Assessors Map and Parcel
a cq L,6cne. P® 6GX 10-7 Owner Address � ��/�
Og
�es�nnnd Wd� ty Ah- Ayt," . PU fZX ��Ig3 r 0 t Lan s M h 02-G g3
Installer-Driller 0Address
Type of Building Dwelling J
Other-Type of Building No. of Persons
Type of Well L4 cr PV6- '��Ckt._ 4n Capacity
Purpose of Well
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 Certifica f Compliance h en issued by e Board of Health.
Signed I 4i�—
Date
Application Approved By
Date
Application Disapproved for the following reasons:
Date
Permit No. � � Issued
Date
--------------------------------------------------------------------------------------------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of Compliance
THIS IS TO CERTIFY,that the individual well Constructed( i Altered( ), or Repaired( )
QInstaller
at Q-'n
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Wel Pro ction
Regulation as described in the application for Well Construction Permit No.1a ' c" -O/� Dated 70 ��b
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORILY.
Date Inspector
1
t-
.
•4 1
No, ,�1` ��-ram—®1 Fee �
BOARD OF HEALTH r
TOWN OF BARNSTABLE
I-�
01ppYicatiou or Veer Cou5tructiou Permit
ND
Application is hereby made for a permit to Constructfy,), Alter( ), or Repair( ) an individual well at:
317 kadi,;,. OA , (U 43arn,Cf bLe; 13 !i /ot o
Location-Address Assessors Map and Parcel"
J c�c cj ,u�lu-Le. 6e li s I P, �P o 96x f®-7 J- S c�r nc,-hm b 6— M A-
��
Owner Address ' U� COG
�rn�r� 1�Ue11 Y 11�rF, Ir�cj . P� 7R�, r n� Clh N� o2r.c 5�
Installer-Driller 01Address
Type of Building /
Dwelling
Other-Type of Building No. of Persons
Type of Well Lj r V� �0_-( Capacity
Purpose of Well &o mc,2 )a
,
Agreement:
The undersigned agrees to install the afore described individual well in accordance with the provisions of the
f Barnstable Board of Health Private We11.Protection Regulation-The undersigned further agrees not to place the
Town"o
well in operation until a Certificate of Compliance has'been issued by the Board of Health.
Signed
ee Date
Application Approved By / " "' &)/A `�)a
Date
-'— Appl cation Disapproved for the following reasons:
In
/ h Date
Permit No. V3c)Z>o -- O Issued
Date
«�•e�� ----_ --- ��_._.a. tee._ .�» ea���P,, ._ —..m_---►s_.--
" BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of Compliance
s +A
THIS IS TO CERTIFY,that the individual well Constructed Altered( ), or Repaired( )
V t Installer
~ at ZA
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well,Protection
;rya; Regulation as described in the application for Well Construction Permit No. Dated 10
,j 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
Vern Cou.5tructiou Permit
No. l.� 9�c=� �d�` Fee
Permission is hereby granted to =vll�C�(�G� f' �` I F ( r1c\ ncC
Installer J'
to Construct( ), Alter( ), or Repair O an individual well at:
No. �)-Z 1 Qt--k+-P- G4 r ye)al D1 -44 IC/1L,
Street ec� /
as shown on the application for a Well Construction Permit No. ���d 3 r9 —0/"i Dated 6 J�tDJ Z�CR
Date (Oft (0 � � •r Approved By—
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