HomeMy WebLinkAboutFruit St. #550 - 3/27/1998MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
AName 5i/ P/-AIV A/!'CJ&-7Z
" ,Address 5-5V Feu / 7- S/— rn r�iv i ez
Location
Registered /-
Well Driller
TYPE OF WELL:
Domestic Potable (for household use)
-KDomestie 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: `
The above appli
following use at
Industrial/Commercial $ 100.00
Applicant
N/C Agricultural
PERMIT TO DRILL A WELL
has bee"pproved and permission is granted to drill a well for the
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 bu ' . s f agriculture)
Date: iC Approved by:
r e 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.