HomeMy WebLinkAbout Carriage House Ln. #23 - 6/30/997MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name c'
Installer
TYPE OF WELL:
Domestic Potable (for household use)
3CDomestic 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: V Domestic $ 10.00 _Industrial/Commercial $ 100.00 N/C
Date: L _ Applicant Signature \` t-
PERMIT TO DRILL A WELL
The above application has been approved and permission is granted to drill a well for the
following use at r'
_Domestic Potable (for househc'_i use)
omestic Auxiliary (for watering, pools, etc.)
_IndustriaUCommercial Potable (for human consumption, including food processing)
—Industrial/Commercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
Date: �;� �� Approved b
sthe Board of Health
NOTE. Electrical permit required, underground cable trench must be inspected