HomeMy WebLinkAboutCarriage House Ln. #24 -7/25/1997APPLICATION FOR PERMIT TO DRILL WELL
Name L—O h Vi �T7i v I C
Locationwv
f-vn(ksk-� MA
TYPE OF WELL:
"U 1 Ce
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.)
_Agricultural (for irrigation of land in the business of agriculture)
Fee: Domestic $ 10.00 —Industrial/Commercial $ I100^.00 N/C Agricultural
Date: �oZ� 1' �Applicant Signature: �� —
The above application
following use at
PERMIT TO DRILL A WELL
and permission is granted to drill a well for the
Domestic Potable (for household use)
_ omestic 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)
Date: o�j Cj 7 Approved by: JC t� ' 'SLI \ 'ice (^ Qr
G
For the Board of Health
NOTE. Electrical permit required; underground cable trench must be inspected