HomeMy WebLinkAboutHarding Ln. #9 - 6/12/2013MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name 914f (f / Y�o /—.
Address:
Location:
Telephone ,5-6 ✓� S 7� �4i
Registered
Well Driller: MA Lic #
Address: /5 'f G L/r 040 i9 A9V
TYPE OF WELL:
Domestic Potable (for household use)
Domestic Auxiliary (for watering, pools, e
Industrial/Commercial Potable (for human
Industrial/Commercial Auxiliary (for mane
Fee: Domestic $75.00
Date:
Applicant Signature:
PERMIT TO DRILL WELL
$75.00
The above application has been approved and permission is granted to drill a well for the
following use at 67
Aomestic 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 busi4s~s�of agriculture)
Date: ' tpproved by:
or 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.
Ras,>s H/
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