HomeMy WebLinkAboutFieldstone Dr. #27 - 8/4/1997MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
'Name (Y\' A k,lQti
Address F \e p S `�� o, Id tf
Location
Installer
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: jVDomestic $ 10.00 _Industrial/Commercial $ 100.00 N Ag cultural
Date: Applicant Signature: T N--
PERMIT TO DRILL A WELL
The above application has
following use at `Z 7
and permission is granted to drill a well for the
Domestic Potable (for household use) -
—P�pomestic 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 bus ess of agriculture)
i
Date: Approved by:
-4� l b the Board of He
NOTE: Electrical permit required; underground cable trenci<i must be inspected