HomeMy WebLinkAbout Deer Path Circle #2 - 7/16/1997MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name
D29
Location
1
TYPE OF WELL:
Domestic Potable (for household use)
omestic Auxiliary (for watering, pools, etc.)
_IndustrialCommercial Potable (for human consumption, including food processing)
_IndustriaUCommercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
Fee: Domestic $ 10.00 _Industrial/Commercial $ 100.00 NIC�JAgriicuu�ltural
Date: -17- ((0- q 7 Applicant Signature:
PERMIT TO DRILL A WELL
The above application has ben approved�,nd permis ion is granted to drill a well for the
following use at 0 f�Ct'1� C,l K GC.i_
Domestic Potable (for hoijcPhold use)
1omestic Auxiliary (for watering, pools, etc.)
_IndustriaUCommercial Potable (for human consumption, including food processing)
—Industrial/Commercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
Date: '7- «- / 7 Approved by
1lwiL112t k (t om
For the Board of Health
NOTE. Electrical permit required; underground cable trench must be inspected