HomeMy WebLinkAboutFruit St. #546 - 4/21/1998MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Location X 009 e 9 f
Registered AO,
Well Driller 4VI
Address
TYPE OF WELL:
em
_Domestic Potable (for household use)
_wPomestic 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: jZDomestic $ 10.00 —Industrial/Commercial $ 100.00 N/C Agricultural
Date: "� ®®9� Applicant Signature:mAW
The above application
following use at _
PERMIT TO DRILL A WELL
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 business,9f agriculture)
Date: Lf' c4 — ! X Approved by: ( /'`-_-- �.".--
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.