HomeMy WebLinkAbout Emerson Circle #19 - 7/7/1997Name
Location
MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERAUT TO DRILL WELL
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TYPE OF WELL:
omestic Potable (for household use)
Domest ic 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: omestic $' 10.00 Industrial/Commerc_ialr$ 100.00 N/C Agricultural
�/� � (_,�/ �1
Datelicant Signature:
The above application
following use at
PERMIT TO DRILL A WELL
rol
is granted to drill a well for the
Domestic Potable (for househc' : use) —
✓bomestic Auxiliary (for watering, pools, etc.)
_Industnal/Commercial Potable (for h-:3n consumption, including food processing)
Industrial/Commercial Auxiliary (for manufacturing, etc.)
-:::Agricultural (for irrigation of land in the business of agriculture)
Date: �ipproved by.
r e Board of Health
NOTE: Electrical permit required; underground cable trench must be inspected