HomeMy WebLinkAboutAngelina Ln. #48 - 3/17/1998MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name
Address
Location SI-4 9e,
Registered
Well Driller
Address
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 manufacturing; etc.)
_Agricultural (for irrigation of land in the business of agriculture)
Fee: 4_Domestic $ 10.00 _Industrial/Commercial $ 100.00 _ C Agricultural
� J
Date: �� Applicant Signature:
PERMIT TO DRILL A WELL
The above application has b e approved and permission is ranted to drill a well for the
following use at(st A d t / Gu
Doomestic Potable (for household use)
mestic Auxiliary (for watering, pools, etc.)
_Industrial/Commercial Potable (for human consumption, including food processing)
Industrial/Commercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irri�gat^ion of land in the busi ess of agriculture) (�
Date: 3 .,_ C 2 - Approved by: e,2
For the Board of Health
NOTE: Electrical permit required, underground cable trench must be inspected
Upon installation of well, call Department of Public Works office at
261-7331 to be added to well list.