HomeMy WebLinkAbout Carriage House Ln. #15 - 6/24/1997MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name
Location �9m`
Installer
TYPE OF WELL:
Domestic Potable (for household use)
p_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: Domestic $10.00 Industrial/Commercial $ 100.00 N/C Agricultural
Date: Applicant Signature:
PERMIT TO DRILL A WELL
The above application has been approved and permis on is granted to drill a well for the
following use at / — h,�t/����fi rz�— /z
_Domestic Potable (for household use)
LL-Domestic Auxiliary (for watering, pools, etc.)
IndustrialCommercial Potable (for human consumption, including food processing)
_IndustrialCommercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the busines§Af agriculture)
Date:. Approved by:
FA the Board of Health
NOTE: Electrical permit required; underground cable trench must be inspected