HomeMy WebLinkAboutDeer Path Lane #32 - 7/24/1997C-
Name
Address
MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT' TO DRILL WELL
Location sY� nr(p--
Installer
Address
TYPE OF WELL:
Domestic Potable (for household use)
Domestic 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)
Fee: v Domestic $ 10.00 _Industrial/Commercial $ 100.00 N/C A ricultural
Date: -115t YI9 -7 Applicant Signature:
PERMIT TO DRILL A WELL
The above application has bee{ approved and permission is anted to drill a well for the
following use at 3'), b t� 2 t04-f-H L-h-r j E,
omestic Potable (for household use)
_Domestic 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: j Approved by: 40d- 4 'k
For the Board of Health
NOTE. Electrical permit required; underground cable trench must be inspected