HomeMy WebLinkAbout3413 MAIN ST./RTE 6A(BARN.) - Health i
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3413 Main St.
.. 0.
Barnstable
No. W)-o�7—0 / Fee
BOARD OF HEALTH
TOWN OF BARNSTABLE
01ppYication jfor Yell Con.5tructton Verna a-lC1 / v L.3
Application is hereby made for a permit to Construct�Alter( ), or Repair( )- an individual well ate
^Locaction�-Address -Assessors Map and Parcel
Owner Address
Yri(96.,. tom. C) - \-6d 4
Irlstaller-Driller Address
Type of Building
Dwelling
Other-Type of Building No. of Persons
Type of Well kYYa, cd c C) l0 LA', 1pY G 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 Certificate of Compliance has been issued by the Board of Health.
Signed
G Date
Application Approved By VVA
Date
Application Disapproved for the following reasons:
II Date
Permit No. W �0 (z Issued
ate
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BOARD OF HEALTH
TOWN O'F BARNSTABLE
Certificate of �on� hance
THIS IS TO CERTIFY,that the individual well Constructed( Altered( ), or Repaired( )
by 'ALL
tt I 1 Installer
at ��-� .� `�CilYl �1 �YnSkd�✓
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 SATISFACTORILY.
Date Inspector �— �^—L�( Z L� r
No.�,j).o `-j D -7 +a„' Fee
•d.. BOARD OF HEALTH
TOWN OF BARNSTABLE
01ppricatiou _for Yell Cou5tructiou Permit aII
Application is hereby made for a permit to Construct Alter( ), or Repair( ) an individual well aY
Location-Address Assessors Map and Parcel
Owner Y' ' I Address
ill l Lay d /A6aw) Kck"(6 r�p�
In'staller-Driller - S Address
Type of Building � •
Dwelling
Other-Type of Building No. of Persons
Type of Well 1 Y Y i(AA cA t n r LA" Py L 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 Certificate of Compliance has been issued by the Board of Health.
Signed
Date
Application Approved By �'� 1t I�C- ' -e ��� --,)- I
Date
Application Disapproved for the following reasons:
" r}
` Date `
Permit No. `.J U 15- Issued
r
Date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of mc Yiauce
THIS IS TO CERTIFY,that the individual well Constructed Altered( ), or Repaired( j
by 'ALL C�. ��11�14
Installer
at • li��Y n1sk A�
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 SATISFACTORILY. /
Date °� Inspector 1'1 t �( .-�i -2- (-16L-
BOARD OF HEALTH
TOWN OF BARNSTABLE
' )
Yell Cou5tructiou Permit
No. LJ -0 I-7 Fee (-/ ' , _
' Permission is hereby granted E UCC,,yp C �V QA\ r
Installer
to Construct Alter( ), or Repair( an individual well at:
Street
as shown on the application for a Well Construction Permit No. Dated r2
Date Approved By
i
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SITE PLAN. GF_ '.:LAND
t.ac.tnoTl- - 3413 i JAIN.5T 15ARNST-A�LC 6IA
eGSAN E. MURFHY
GR.1v J DY
o2J,Ti
WELLER & ASSOGIAI-ES..
j s f r ia(currt,R su-Irc 4C CENfvVR.LE.6U o2532.
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