HomeMy WebLinkAboutHarvestwood Ln. #7 - 8/28/1997MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
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,=Address %
Location
Installer
Address
TYPE OF WELL:
a
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: Domestic $ 10.00 Industrial/Commercial $ 100.00 N/C Agricultural
Dater '✓ Applicant Signature: 1 ¢., ��Z/)Lj )Q
PERMIT TO DRILL A WELL
The above application has been approved and permission is granted to drill a well for the
following use at " U.n,-mA —
Domestic Potable (for household use) _
Domestic Auxiliary (for watering, pooh, etc.)
_Industrial/Commercial Pr-oblc (for human consumption, including food processing)
_Industrial/Commercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
Dater ci Approved by: cif,
` Forhhe Board of Health
NOTE. Electrical permit required, underground cable trench must be inspected