Loading...
HomeMy WebLinkAbout1077 PLEASANT PINES AVE - Health 10071 pleae.5a�n�-3- ' wrest' 8 ►'s'kb'1 .. .1Ll - 1 "' W 0 No.-�-5!r- Fee--_. -- BOARD OF HEALTH TOWN OF BARNSTABLE Applicat ion,for Vell Con0ruct ion Permit we'd O)ACA Application is herebymade for a permit to Construct ( ), Alter ( ), or Repair (man iin/d�ifvidual Well at: d ) '-------f___/--4- 4 A � —— —----—-- t -��- a°—�l-- —------- ---- — —— — P ---- Location — Address Assessors Ma and harcel S r-eJe O(�.v e c7 7 Plea C,. T fo,—C f ------------------------------------------------------------------------- --------------------------------------------------------------------- /_ w - / Address e � '60, 0,,, �Cv —— ----------- �- Installer Driller Address Type of Building Dwelling----- Z'raeS=e - ---------------------------- Other - Type of Building---------------------------- No. of Persons.-------------------------------- Type of Well Capacity-------------------—--- - - -- Purpose of Well_b_o es -r' ---------- - 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 . f Compl'ance has been issued by the Board of Health. Signed -- -- -- -- ------------------ - -`r�l�1 --------- date Application Approved By-- --� ��`` - - --4-f- to •�� V------------- °ate --- Application Disapproved for the following reasons:--- --------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------- Permit No. - - - L-f 1, date - ---- ---------- Issued--------------------------------- ---— -------------- date BOARD-OF HEALTH TOWN OF BARNSTABLE (Certif rate ®f (Compliance THIS IS TO/C�ERT FY, That the Individual Well Constructed ( ), Altered ( ), or Repaired by----------------A-Al6tt w1_/f------------------------------------------------------------------------------------------------------------ — ------ Installer at-—� /e Ce SGv — —— �v� f' f —— ---------- 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.w "-- -----Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-- - --- —-- - -- — - -- Inspector----------------------------------------—- - ----------- No.- - -�'---- Fee---P- z----- BOARD.OF HEALTH TOWN OF BARNSTABLE,_ � nlicationArVell Contructionperntit Application is hereby�made for.a permit to Construct ( ), Alter ( ), or,Repair (lean individual Well at: Location - Address , `Assessors'Map and Fircel Owner Address ? i f e' �.,�ai,� l(cI MG,s �s t�� 1 T Of Building Installer — Driller ---— — - Address— - — ype. 8. 'r Dwelling L,nu 5 e Other - Type of'Building----- -- - No. of'Persons----- -------- ----- -- Type of Well- - Capacity-- ----- - - — -—— --- I Purpose of Well .'00"", T>-C. ----------------- - .-- Agreement The undersigned agrees to 'install the aforedescribed individual well in accordance with the provisioris of The f Town of Barnstable.Board of Health Private Well Protection Regulation - The undersigned.further agree's not to place the well in operation.until a Certificate . f Compliance has been issued by the Board of Health. Signed --. Gr'"4 - -- -- ---- = >� 6 �" -------- date k Application Approved By. --- -- - -V (. ______ ______- _________ _-_____-- __-_-____-- ___-________ Application Disapproved for the,following reasons:---= --- --- — — — --- - --- - - - _ - - date Permit.No. - - ti� - ----- --- - Issued --- ------- - - - - --- -------- date ' r. BOARD OF HEALTH TOWN OF BARNSTABLE of c�ertifit.ate Of compliance THIS IS TO CERT FY That the Individual Well Constructed ( ) Altered ( ),,or Repaired by --------- -© _Eu!�+n.- - ---------- -- --- - --- - - - -- --=---- Installer at--� 2- /�G�Gti._!— _> r_a_�_f_ �_--- ------------- -------------- ------- -------- 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�- j-----Dated �}�=`-.� }�- j°✓�- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. . �—- -- Inspector DATE---- ------------- — - —-- - ---= - I BOARD OF HEALTH i i TOWN OF BAR�NSTABLE. Well con5tructipPermit r • No. - - ---- Fee-- �3�- -- --- f Permission is herebyranted `! ,8 - = ----- - ----—=---- - - to Construct ( ), Alter ( ), or R pair ( oran Individual Well at: Street as shown on the application for a Well Construction Permit No.- =_ ----- - ---- -----—--- - Dated=-- j� ------ i Board of Health DATE R