HomeMy WebLinkAboutDeer Path Circle #27 - 3/31/1998MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name 9 DBE ( + LDP Q d 1 t ilE S rTC8,b ni /9N
Address Q`% EEIP POT8 LlANL "1`fS(-t( LD
Location_
Registered
Well Driller -_-EILF
TYPE OF WELL:
_Domestic Potable (for household use)
2bomestic 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 _IndustriallCommercial $ 100.00 N��/��C Agricultural
Date: I j (q Applicant Signature:(Q'i i7�Lt><�SK'1a�SV+ti
PERMIT TO DRILL A WELL
The above application has been apprgved and permission is granted to drill a well for the
following use at c� % , ?`'d= e4-T7-1 W /--)
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 bus' so agriculture)
Date: 3 — 'J ' �7 Approved by:
Fort and 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.