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HomeMy WebLinkAboutFruit St. #516 - 8/28/199701 00KI 011 AXT671yel W to 1 01011 APPLICATION FOR PERMIT TO DRILL WELL K Name 114—Address ti l for Location Installer r�1 , r Z' t:G Address 1 r ,,, q-. I ; , , = . _ ` - 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 IndustriaUCommerciall $$ 100.00 N/C Agricultural Dater _,"Applicant Signature: PERMIT TO DRILL A WELL The above application has been approveriand permission is granted to drill a well for the following use at1 Domestic Potable (for household use) _ 'amestic 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: r%f Approved by: r Board of Health NOTE. Electrical permit required; underground cable trench must be inspected {\w } \ /� ^ ( r /� \ / / / 7 \ \ /\ IM =9mmq±7y LD „ <�m� § \\§[)a!> �(2\ ; 4 4 cn !z s e 0) / \5`! {\.\\m o\ 2 2 . rm >)_) _ © m :; . a m,j k \� � \ j\§ *2(;\ . }/j ° {{\\\\}{®;< 32 ƒ&, \\E(\2§g 2) }§ m 'o: / § ¢< 2 [& Aa �� OR ;. ° S,3j ®«a i