HomeMy WebLinkAboutFieldstone Dr. #7 - 2/25/1998MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name o y C c
Sa ,
Installer
TYPE OF WELL:
Domestic Potable (for household use)
Domestic Auxiliary (for watering, pools, etc.)
IndustriaUCommercial Potable (for human consumption, including food processing)
_IndustriaUCommercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
Fee: 'Domestic $ 10.00 _Industrial/Commercial $1100.00 N/C Agricultural
Date: / �% Applicant Signature,,.
PERMIT TO DRILL A WELL
The above application has been approved and
following use at :2 h � LA S %/D`
is granted to drill a well for the
Domestic Potable (for household use)
_✓Domestic Auxi"qry (for watering, pools, etc.)
_IndustriaUCommercial Potable (for human consumption, including food processing)
_IndustriaUCommercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
Date: ) /) q � Approved by: CO �t L
For the Board of Health
NOTE: Electrical permit required; underground cable trench must be inspected
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