HomeMy WebLinkAboutCarriage House Ln. #31 - 8/25/1998MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name ►� ..R^ L���� S Tn �c
Address Telephone
Registered Well Driller k' 7r- �-t, tJ f1 Number o E t
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pomestic 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 business of agriculture)
Fee: iZ Domestic $ 10.00 Industrial/Commercial/$ 100"0 N/C Agricultural
Date: c-;;'-2 '-' � Applicant
The above application
following use at _
PERMIT TO DRILL A WELL
and permission is granted to drill a well for the
C, s f,; ! P> l o n L.-
Domestic Potable (for human consumption)
_LLDomestic Auxiliary (for landscape watering, pools, etc.)
_industrial/Commercial Potable (for human consumption, including food processing)
—industrial/Commercial Auxiliary (for
_Agricultural (for irrigation of land in
Date: '��/ h Approved
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.