HomeMy WebLinkAboutHolstein Rd. #14 - 4/18/2002MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name UILi i Kobe-f't K.rCll
Address: 14 �Oari
Location:
Registered
Well Driller:
Address: _ L�� iAdAel CA- l -O Q 3Z-
TYPE OF WELL:
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.)
_ A, g/ricultural (for irrigation of land in the business of agriculture)
Fee: IY� Domestic $10.00 _ Industrial/Comme(rccial�$100.00 N/C Agricultural
Date: O�1-3.(0Z Applicant Signature:
PERMIT TODRILLWELL
The above application has b en approved and per Sion is granted to drill a well for the
following use at ! `
Domestic Potable (for household use)
15omestic Auxiliary (for watering, pools, etc.)
_ IndustriaUCommercial Potable (for human consumption, including food processing)
_ IndustriaUCommercial Auxiliary (for manu
fa etc.)
Agricultural (for irrigation of land in the. b mess 9f agriculture) -
Date: 2 ` T-oo EYpproved by:
r 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
261-7331 to be added to well list