HomeMy WebLinkAboutDeer Path Lane #28 - 7/25/1997MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name O CotiN E LL.
Address 2.
Location Sa.w.e
Installer
TYPE OF WELL:
Domestic Potable (for household use)
XDomestic 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)
Fee:
>z Domestic $ 10.00
_Industrial/Commercial
$ 100.00 NICnnAgtricultural
Date:
'%-0111l q 7
Applicant Signature: �c'
� -E•
The above applii
following use at
PERMIT TO DRILL A WELL
and permission is granted to drill a well for the
_Domestic Potable (for household use) -- -
Vbomestic Auxiliary (for watering, pools, etc.)
Industrial/Commercial Potable (for human consumption, including food processing)
_IndustriaUCommercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
Date: a Approvedby: S&vf-&,k G,'
For the Board of Health
NOTE: Electrical permit required; underground cable trench must be inspected