HomeMy WebLinkAboutAngelina Ln. #24 - 8/20/2002MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name ; ; i / 3 s � - 15 �
Address: �)'/ Ai,- /j n:i i, / /4
Location:
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: X Domestic $10.00 Industrial/Commercial $100.00. ; Vim/ Agricylitural
Date: 1`, ' j /, Applicant Signature: �! �, .1 't� r ni
PERMIT TO DRILL WELL
The above application has b en approved and
following use at -?!+ A-4&E"tva
is granted to drill a well for the
D estic Potable (for household use)
estic 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 th s of agriculture)
Date: 1D Q Approved by: -- ,
or 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
261-7330 to be added to well list.