HomeMy WebLinkAboutCarriage House Ln. #4 - 6/25/1998MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name 134 � r,,t GrAl Y A P Ed if✓��
Address ,As�N �(rn/= &r rz L Telephone 9 - 2y-jP1�
Registered Well Driller \A 9,
TYPE OF WELL:
mestic Potable (for human consumption)
mestic Auxiliary (for landscape watering, pools, etc.)
Industrial/Commercial Potable (for human consumption, including bci
_—Industrial/Commercial Auxiliary (for manufacturing, etc.) n;
_Agricultural (for irrigation of land in the business of agriculture)
Fee: Domestic $ 10.00 —Industrial/Commercial $ 100. N/C Agricultural
Date: 6r/.711 5'zP Applicant Signature:
The above applicatio has been approved and
following use at `�% 1 < ° .,7 a r
to drill a well for the
_Domestic Potable (for human consumption)
_Domestic Auxiliary (for landscape 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 basin s of agriculture)
Date: Al Approved by:
Fob a Board of Health
Follow-up notes for after the well is drilled.
1. Electrical permit required, underground cable trench must be inspected
2. Upon installation of well, call Department of Public Works office at 261-7331 to be
added to well list
3. Display "Well Water" sign.
I