HomeMy WebLinkAboutAngelina Ln. #40 - 5/28/19991 ' 1
APPLICATION FOR PERMIT TO DRILL WELL
Name
V
6 AA2, 1-J4A
Address
40 /1N6-01-1,v 19
1-A Telephone
15- o e d 6 /• 9/
Registered Well Driller G-6 0 2 Grt= Z A nJ c_ e- t-A 7 n Number
Address & 6-Au P L4- s 7-/3 P J 6 6-E 40 A7 -C-ee i_12 /2 0 a 3 a il Jb d'6 9 7-a874
TYPE OF WELL:
Domestic Potable (for human consumption)
Domestic Auxiliary (for landscape 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: 0
_Domestic $ 10.00 Industrial/Commercial $ 10.00 N/C Agricultural
Date 6"lablg9 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 at
Domestic Potable (for human consumption)
✓omestic Auxiliary (for landscape 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 b essoculture)
Cc
Date: ' Approved by:
For the -board of Health
Follow-up notes for after the well is drilled:
1. Electrical permit required; underground cable trench must be inspected
2. Upon installation of well, call Department of Public Works office at 261-7331 to be
added to well list
3. Display "Well Water" sign.