HomeMy WebLinkAboutCottage St. #104 - 3/24/1998,Name Ny c
MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
CGl�(Ar (4cf,�
Address CCIfFGS¢
Location I o �,l CCU r c, SSZ S 1 '
Registered
Well Driller
TYPE OF WELL:
_Domestic Potable (for household use)
Domestic Auxiliary (for watering, pools, etc.)
_Industrial/Commercial Potable (for human consumption,
_Industrial/Commercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the busines
Fee:(= —Domestic $ 10.00 _Industrial/Comme
Date: 3' d ��� (%Applicant Signature
The above appli
following use at
including food processing)
PERMIT TO DRILL A WELL
and permission is granted to drill a well for the
Domestic Potable (for household use)
QCDomestic Auxiliary (for watering, pools, etc.)
_industrial/Commercial Potable (for human consumption, including food processing)
_Industrial/Commercial Auxiliary (for manufac g, etc.)
_Agricultural (for irrigation of land in the b 'n of agriculture)
Date: Approved by:
o e Board of Health
i 4!h c;{' hien r'i-Jd
NOTE: Electricalpermit required, undergrouird cablifhidildi[fintat ti8vitsperted
Upon installation of well, call DepartmentCr11)l'c°`Works office at
261-7331 to be added to well lisp i,i„i;