HomeMy WebLinkAboutColonial Dr. #78 - 6/29/2000Slgrfe(we oisupervismg"regsseredwell duller
Supervising Driller Reg.#
Please print firmly BOARD OF HEALTH COPY
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Supervising Driller Reg.#
Please print firmly BOARD OF HEALTH COPY
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APPLICATION FOR PERMT TO DRILL WELL
Name -P" f %�� EI J
Address —7 9 C,01a ✓1 JA Iyn
Location j3/jCK L k-F� C a N e k 6,4-'
Registered
well Dril er 4U C 1l o D Wed r 6y"ll
Address 'fti A f f Sr ,&Ao/n16- �rM . a1867
TYPE OF WELL:
_Domestic Potable (for household use)
Domestic Auxiliary (for watering, pools, etc.)
_Industrial/Commercial Potable (for human consumption, including food processing)
—Industrial/Commercial Auxiliary (for mantifaeturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
Fee: . _
_Domestic 0.0 Industrial/Commercial S 100.00 1& Agricultural
Date: Applicant Signature,
PERMIT TO DRILL A WELL
The above application has been &approved and permission is granted to drill a well for the
following use attiYc--s(Z—
Domestic Potable (for household use)
�IDomestic Auxiliary (for watering, pools, etc.)
Industrial/Commercial Potable (for human consumption, including food processing)
—Ltdustrial/Conunercial Auxiliary (for rnanufacturin c.)
�Agncui al (fo irrigation of lend in the basin iture)
n
Date: Approved by:
Forth oard of Health
NOTE., Etectrlca! permit requirer{ undergrmod cable trench mrar be inspected
Upon installation of well,. call Department of Public Works office at
161-7331 to be added 10 well list
AVELLINO WELL & PUMP, INC.
244A Haven Street Reading, MA 01867 781-944-5454 or Fax 781-944-6625
PROPERTY PLAN TO ACCOMPANY
APPLICATION FOR WATER WELL PERMIT
To": MANSFIEUD MA,
PROPERTY/ADDRESS: 76 C-ot.-DryiA-L, TJ2lU�
HOMEOWNER'S NAME: T61a-A
PROPPLANPERMIT No S fin-t�(- S\ s T)v\ S