HomeMy WebLinkAbout0074 RENDEZVOUS LANE - Health -�--- ► ;
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1336 Phinnys Lane
Barnstable (See Harborside Condo file)
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No. Fee qS
BOARD OF HEALTH
TOWN OF BARNSTABLE
0[pprication jFor lVell Construction Permit
Application is hereby made for a permit to Co t ct ), Alter( ), or Repair( ) an individual well at:
o27 l - �)'Q>
Location-Address Assessors Map and Parcel
Address
Installer-Driller Address
Type of Building
Dwelling
Other-Type of Building No. of Persons
Type of Well --7"inA //( �4/ on Capacity
Purpose of Well V
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 o o ;ance has been issued by the Board of Health.
Signed O XDa
4-7Z
Da
Application Approved B G
PP PP Y r
/
Application Disapproved for the following reasons:
Date
Permit No. Issued
ate
-------------------------------------------------------------------------------------------------------
BOARD OF HEALTH
.TOWN OF BARNSTABLE
Certificate of C�, Altered
riance
THIS IS TO CERTIFY,tha the individual well Constructed(° ( ), or Repaired( )
by
Ins l
at L1,41
has been installed in accordance with the provision of the Town of Barnsta �*e �vate Well Protection
Regulation as described in the application for Well Construction Permit No. ed
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORILY.
Date Inspector
No. / Fee y
v r
BOARD OF HEALTH
TOWN OF BARNSTABLE
01ppYicatiou -for 39ell Cougtructiou permit
Application is hereby made for a permit to Construct ), Alter( );ems or Repair O an individual well at:
Location-Address Assessors Map and Parcel
Owner Address
Installer-Driller Address y
f
Type of Building
Dwelling
Other-Type of Building No. of Persons
Type of Well fl/ (` 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 alwQx4ance has been issued by the Board of Health.
Signed \ c;�A�- /
Q Da
Application Approved By I
Y ! ate
Application Disapproved for the following reasons:
''•►� Issued Date
Permit No.
/44/7
ate
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of Compliance
THIS IS TO CERTIFY,that the-individual well Constructed(Altered( ), or Repaired( )
by
atI le,
c /
has been installed in accordance with the provisions of the Town of Barnsta 1 ar �Iealt ivate Well Protection
Regulation as described in the application for Well Construction Permit No, ted
I
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORILY.
Date Inspector
e-vmv_e___ed_-ee40000..-_eo_oe4_omvoe_em_om_se°oo4°em__sm.,_omm_a_-a_b_e__o__emv_------ -------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Ivell Cou.5tructiou permit �-
No. I e)l
Fee 4
V n-
Permission is hereby granted.tof4��
Installer
to Construct Alter( ), or Repair( an individual well at:
.� Street ..
as shown on the a plication fo a We C struction Permit No. ( / ate A// / ,
Date / L/
Approved By
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