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HomeMy WebLinkAboutHarvestwood Ln. #39 - 7/9/1999APPLICATION FOR PERMIT TO DRILL WELL Name xf%fia �N_ �/, flac)E oyl Addresses /�faryes�w Cage -/�lc� Location 15 1 Tidli% �rdil%et`r 1—elw— LG(wy iiJl� Ge� 2 e- 'qt 7777a C Q%% Registered Well Driller Address . ©. X _ 566 U)00 95eCxe+. T !9mg5 TYPE OF WELL: 001�76Z~`61Y 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 $ 100.60 N/C Date: TU 1 Y 4, H19 Applicant Signature: PERMIT TO DRILL A WELL The above application has beenaappproved and permission is granted to drill a well for the following use at 9 I—AVE. omestic 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) (_ g Date: � Approved by: "llepCT `�_�1 d-�.. iA For the Board of Health 'P 6/ 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