HomeMy WebLinkAboutCarriage House Ln. #30 - 7/1/1997MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name J 06 v - a
Address
Location
Address. G j
TYPE OF WELL:
0
M
_Domestic Potable (for household use)
'EDomestic Auxiliary (for watering, pools, etc.)
_Industrial/Commercial Potable (for human consumption, including f6 process`Yn )
_Industrial/Commercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
Fee: A Domestic $ 10.00 _Industrial/Commer 'al $ MOM NN/ Agricultural
Date: I L q� Applicant Signature: W YIIYIkUV
PERMIT TO DRILL A WELL
The above application has
following use at �3o_-1
and permission is granted to drill a well for the
Domestic Potable (for het ceho': use) �26omcstic Auxiliary (for waterier„ pools, etc.)
_Industrial/CommRrcial Potable (for human consumption, including food processing)
Industrial/Commercial Auxiliary (for manufacturing, etc.)
_
Agricultural (for irrigation of land in the business of agriculture)
Date: (r L`2 Approved by
Uri
For the Board of Health
NOTE: Electrical permit required, underground cable trench must be inspected