HomeMy WebLinkAboutDean St. #151 - 6/30/1999MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name ..T
Location Z?9C/r Y-'2.e4 n eA.Q THE CE!!9P Eti TPy CE
Registered
Well Driller
Address
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 _IndustriaUCommercial $ 100.00 N/C Agricultural
Date: d 9 9 9 Applicant Signature:
M
PERMIT TO DRILL A WELL
The above application has been approved and permission is granted to drill a well for the
following use at _ J �l lga _ r �t
_Domestic Potable (for household use)
vDomestic 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 businmo agriculture)
Date: �7— Approved by:
Fo a 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