HomeMy WebLinkAboutHighland Ave. #125 - 6/25/1997Name
12
Location
Installer
Address
MANSFIELD BOARD OF HEALTH
APPLICATION FOR
TYPE OF WELL:
TO DRILL WELL
G
Domestic Potable (for household use)
Domestic Auxiliary (for watering, pools, etc.)
_IndustrialCommercial 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
Date: 2s � Applicant Signature: / c0' �/ j, F„
-� =r
The above application
following use at L�
PERMIT TO DRILL A WELL
approved and permission is granted to drill a well for the
_Domestic Potable (for h- -ehold use)
Domestic Auxiliary (for watering, pools, etc.)
_IndustriaUCommercial Potable (for human consumption, including food processing)
_IndustriaUCommercial Auxiliary (for manufacturing, etc.)
Agricultural (for irrigation of land in the business of agriculture)
Dat� 2j Approved :
r the Board of Health
NOTE: Electrical permit required, underground cable trench must be inspected