HomeMy WebLinkAboutFieldstone Dr. #19 - 7/1/1999MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name j0 s ,� P la A - V� i- 5 I
Address 0 F=t et tl5pL TSc \ yr s r_lul)
Location S rn�c f@5 Ao t v-A�
Registered
Well Driller GctQ_sC 2c�nei(�ko
Address (oS LcuI b66��arlc.r tqv, toc32d
TYPE OF WELL:
D mestic Potable (for household use)
omestic 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: c' Domestic $ 10.00 —Industrial/Commercial $ 100.00 N/C Agricultural
Date: V i 1 Applicant Signature: kiA'Wei—
UU
PERMIT TO DRILL A WELL
The above application has been approved and permission is granted to drill a well for the
following use at _Lai_— t 1=L STY) 4FL_ _i 1ef__
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 i igation of land in the business of a riculture)
Date: ,\L_)�4 I Approved by:
Fort oard 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.