HomeMy WebLinkAboutEast St. #912 - 12/28/2009 & 1/7/2010MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Address: 9/Z C-sT S
Location: -�e%lit side � W-Qse
Telephone 5-4 Z 9 y vl (,S
Registered
Well Driller: � r-T tied well /7e %lb l�a� o C�1svr t MA Lic # K
Address: /G z r?- (ymp74 , ST I�1 DDir P ao ) /F
TYPE OF WELL:
CIOS'�'Gi Co �cd��(�Crh�( �C/l5
Domestic Pota le (for household use)
Domestic Auxiliary (for watering, pools, etc.)
T hidustrial/Commeroial Potable (for human consumption, including food processing)
_ Industrial/Commercial Auxiliary (for manufacturing, etc.)
Agricultural (fot irrigation of land in the business of agriculture)
Fee: Domestio $10.00 _ Industrial/Commercial $100.00 NIC Agricultural
Date: 1:�-c; Z F' Applicant Signature:
PERMIT TO DRILL WELL
The above application h4 been approved and
following use at.
_ Domestic Potable (for household use)
Bemestic Auxiliary (for watering, pools, etc.)
_ Industrial/Commercial Potable (for human consun
_ Industrial/Commercial Auxiliary (for man
_ Agric tural ( r irrigation of land in usin s
Date: ( 2 � 6 Approved by:
For
to drill a well for the
including food processing)
Board of Health
NOTE. Electrical permit required; underground cable trench must be inspected
Upon Installation of well, call Department of Public Works office at
261-7330 to be added to well list;
MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name RA9 PernA49�lb
Address:
Location: (� ; Gt
Telephone
Registered �y
Well Driller. J i � '�71 fl `i� MA Lic # a 6
Address: (%- 2/2v✓Yt �ro pu % a2-3 q-1
TYPE OF WELL:
_ Domestic Potable (for household use)
-V' 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 business of agriculture)
Fee: Domestic $10.00 Industrial/Comm ial $ 0=N/CAulDate: ApplicantSignature:
PERMIT TO DRILL WELL
The above application has been
following use atLl
is granted to drill a well for the
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.)
_ Agric tural for irrigation of land in the b ' s of agriculture)
Date: Approved
r the Board of Health
NOTE. Electrical permit required; underground cable trench must be inspected
Upon Installation of well, call Department of Public Works office at
261-7330 to be added to well list