HomeMy WebLinkAboutDay Ave. #9 - 3/12/1998MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name
Address—
Location —
Registered
Well Driller
Address
TYPE OF WELL:
Domestic Potable (for household use)
YDomestic 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 $ 100.00 NIC Agricultural
Date: 3 Applicant
PERMIT TO DRILL A WELL
The above application has been app oved and p �m�is^sion is granted to drill a well for the
following use at Goad 4 t T
Domestic Potable (for household use)
omestic 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)
Date: Approved by: {& Lt }X
For 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.