HomeMy WebLinkAbout0056 RENDEZVOUS LANE - Health 56 RENDEZVOUS LANE
Bamstable
A= 279 - 031 - 003
o
No. 8 / Fee
BOARD OF HEALTH
TOWN OF BARNSTABLE
Rpplicatiou jfor Yell Cougtructiou Permit
Application is hereby made for a permit to Construct( ), Alter( ), or Repair( ) an individual well at:
5 (=, 2enJe2VOLAS q — 03) -- 0o '3
Location-Address Assessors Map and Parcel
Owne Address
A Si,� T.O ]?At
Installer Driller Address
Type of Building
Dwelling V�nw
Other-Type of Building No. of Persons
Type of Well ' �`(vt CLi a� Capacity
Purpose of Well __T)r v k
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 otect' Regulation-The undersigned further agrees not to place the
well in operation until a Certificate m li ce as n isA-d the Board of Health.
Signed - . 7
Dat
c��
Application Approved B
Date
Application Disapproved for the following reasons:
' s� l Date
Permit No.vim►� ^ Issued
Date
BOARD OF HEALTH
�,, OWN OF BARNSTABLE
Certificate of ConY h uce
THIS IS TO CERTIFY,that the individual-wlell Constructed Altered( ), or Repaired( )
by Al I
Installer
at
has been installed in accordance with the provisions of the Town of Barnsta001�
ard of Health Private Well rote lo>
Regulation as described in the application for Well Construction Permit No. —6) Dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORILY.
Date Inspector
` /
No. ��\ �/ f W Fee q
BOARD OF HEALTH
TOWN OF BARNSTABLE
2pprication for lVerr Con5truction Permit
Application is hereby made for a permit to Construct( ), Alter( ), or Repair( an individual well at:
Location-Address Assessors Map and Parcel
F—woy
J Owner Address
cak W air I nn k d o A H nD �-0SC. --p,O. —ta>6,e 12(- -9,- ,t ��--4ty t4A,�
I Installer/1 Driller / t Address
Type of Building
Dwelling V( C)w e"—
Other-Type of Building No. of Persons
Type of Well y `I ; `1ytA(GL , 6Y ' Capacity
Purpose of Well -T,4 y t c,
A
Agreement:
G 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 P�rotecti Regulation-The undersigned further agrees not to place the
well in operation until a Certificate afiC•mpliance has bee fin issued by the Board of Health.
Signed , { h f j
Datj I
Application Approved By 6 I ) )C
Date
Application Disapproved for the following reasons:
Date
Permit No.v� � ` 0 ) Issued 1
Date
e
------aae----- ------------------e_a-_mv_e.ed. e_eeem___ao__e__be_4_�_e_—.__—
BOARD OF HEALTH
��•, �TOWN OF BARNSTABLE
Certificate of Comp'
om attce
bTHIS IS TO CERTIFY,that the individual,well � Constructed( , Altered( ), or Repaired( )
y A I Icram
r Installer
at
has been installed in accordance with the provisions of the Town of Barnstable Board�f Health Private Well Protection
Regulation as described in the application for Well Construction Permit No. w (N�Dated R 7 I
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
-= ._ Vell. Construction Permit
No. f���`. '�/`>1 —01 Fee
Permission is herebyranted to ,/� /�
g All I�C..�.Q. �/�l�C�
Installer
to Construct(0, Alter( ), or Repair O an individual well at:
_._. �. Street as shown on the application for a Well Construction Permit No. ��1� '� ,—"— Dated I (/ `^1
Date ( / 1 Approved By