HomeMy WebLinkAbout Danielle Lane #15 - 4/23/1998MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
XName l L— i�j A M
Address is �jxxCl `&f LyA
Location
Registered
Well Driller
TYPE OF WELL:
Domestic Potable (for household use)
Domestic Auxiliary (for watering, pools, etc.)
_Industrial/Commercial Potable (for human consumption, including food processing)
—Industrial/Commercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
Fee: Domestic $ 10.00 Industrial/Commercial 10 00 N/C Agricultural
Date: z- �/ G Applicant Signa e:
PERMIT TO DRILL A WELL
The above application h �been approved and permission is
following use at I L J' ll CAE L
to drill a well for the
_Domestic Potable (for household use)
_Domestic Auxiliary (for watering, pools, etc.)
_Industrial/Commercial Potable (for human consumption, including food processing)
_Industrial/Commercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the b 'ness f agriculture)
Date: 2 C Approved by:
r he Board o€„He?lth
NOTE: Electrical permit required, underground cable trench must be inspected
Upon installation of well, call Department of,,, Works office at
261-7331 to be added to well list