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HomeMy WebLinkAboutDavis Street #39 - 8/7/2002MANSFIELD BOARD OF HEALTH - APPLICATION FOR PERMIT TO DRILL WELL; Name Address: Location: Registered Well Driller: Address: LL'-S ChC.0 tAetkfl 'ZTk£r E 8e( 3�- AA ©2 a-7fit TYPE OF WELL: Domestic Potable (for household use) X 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: X Domestic $10.00 _ Industrial/Commercial $100.00 N/C Agricultural Date: 8p2 Applicant Signature: The above application following use at �! PERMIT TO DRILL WELL approved and permission is granted to drill a well for the Domestic Potable (for household use) DC 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 busessaf-griculture) Date: Approved by: the Board of Health NOTE: Electrical permit required, underground cable trench must be inspected Upon Installation of well, call Department of Public Works office at 261-7331 to be added to well list.