HomeMy WebLinkAbout3074 MAIN ST./RTE 6A(BARN.) - Health (2) 3075 MainStreet
Barnstable
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BOARD OF HEALTH
TOWN OF BARNSTABLE
0(ppricatiou _for Yell Construction Permit
Application is hereby made for a permit to Construct)' Alter( ), or Repair( an individual well at:
3 l �ant��S�t' • kc'-'5� 2-) 035
Location-Address Assessors Map and Parcel
Owner t Address UL
Installer-Driller Address
Type of Building
Dwelling
Other-Type of Building No. of Persons
Type of Well '<-,r bY1 �r S CA�y p ���. 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 Certi c �e of Compliance has been issued by the Board of Health.
Signed 3
Date
Application Approved By
Date
Application Disapproved,for the following reasons:
Date
Permit No. V" ll Issued l� P
Date
--------------------------------------------------------------------------------------------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of Compliance
THIS IS TO CERTIFY,that the individual well Constructed( ), Altered( ), or Repaired( )
by
V\e e 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. W cTOP— OV Dated [2A3—/ 3
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORILY.
Date Inspector
= No. Fee
"+ s BOARD OF HEALTH
TOWN OF BARNSTABLE
s".. 2 pprication _for Yell Cottgtruction Permit
Application is hereby made for a permit to Construct), Alter-( ),., or Repair O an individual well at:
01 2DS 1035
Y Location-Address Assessors Map and Parcel
k), S6 P,6-bob. 33 c ns � 0.43—('�
Owner Address
S,-ru„
Installer-Driller Address
Type of Building -
Dwelling J
Other-Type of Building No. of Persons
Type of Well (�J t iN� S(\N(4 f VC 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
,i
well in operation until a Certific to of Compliance has been issued by the Board of Health.
Signed Ny!�
ate
Application Approved By b 3—13
Date
Application Disapproved-for the following reasons: r
Date
Permit No. 0-0 Issued
Date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of Compliance
THIS IS TO CERTIFY,that the individual well Constructed( ), Altered( ), or Repaired( )
by t.
Installer
0
at - t 5 ' �` W . -b
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. Lj*101)a pQV Dated 1„-3-/ 3
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORILY. w.
Date Inspector
BOARD OF HEALTH
TOWN OF BARNSTABLE
VeYr �Cou�truction Permitr
No.00013 00� Fee {
Permission is hereby granted to 1) ►O 6NO 4-0 z L_.C_, —D 2_iLLINC
Installer
to Construct( ), Alter( ), or Repair( an individual well at:
Street
as shown on the application for a Well Construction Permit No. Dated
Date . (� Approved By
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CERTIFICATION
CERTIFY TO THE ABOVE ATTORNEY, RANK,AND THEIR.TITLE INSURANCE ��Wl
PA
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DWELLING WAS IN COMPLIANCE WITH THE LOCAL ZONING BYLAWS(N EFFECT
FFE T E.
STRUCTURAL SETBACK REQUIREMENTS ONLY)OR IS EXEMPT
i.sW TrrLE V1Y,CHAPTER 40A,SECTION 7-
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