HomeMy WebLinkAboutAngelina Ln. #12 - 7/1/1997Name
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MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
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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: _Domestic $ 10.00
Date: � I I I q 1
_Industrial/Commercial 1100.00 N/C Agricultura
Applicant Signature:
PERMIT TO DRILL A WELL
The above application as begg++� app�r+onvqJ d and permission is granted to drill a well for the
following use at i C -ri �C&f ha, L a ka.
Do�-mestic Potable (for household ^)
(il5omestic 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)
Date: 1 r i % / Approved by: '' 44) "'-
For the Board of Health
NOTE: Electrical permit required, underground cable trench must be inspected