Loading...
HomeMy WebLinkAboutFarm Pond Path #15 - 8/5/2002MANSFIELD BOARD OF HEALTH Jam` v� CN APPLICATION FOR PERMIT TO DRILL WELL Name J©N rl Address: 15 Location: Registered Well Driller: f Address: —L-7— TYPE OF WELL: k"ttouSKo S l S tk/gTc2 W/ Domestic Potable (for household use) _ Domestic Auxiliary (for watering, pools, etc.) _ Industrial/Commercial Potable (for human consumptie�c including food processing) Industrial/Commercial Auxiliary (for manufacturing, Agricultural (for irrigation of land in the business of agriculture) Fee: ✓ Domestic $10.00 __ Industrial/Commercial $100.00, NN/C Agricultural Date: g 5 A 5— Applicant Signature: �a pERMIT TO DRILL WELL The above application has been appr and pr is granted to drill a well for the following use at I� _ 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) oved by: Date: PrS 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 261-7330 to be added to well list