HomeMy WebLinkAboutBrook St. #78 - 11/3/1997MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name
Address '�
Installer
Address
TYPE OF WELL:
01
Domestic Potable (for household use)
pomestic Auxiliary (for watering, pools, etc.)
IndustriaUUCommerciai Potable (for human consumption, including food processing)
_IndustriaUCommercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
Fee: �Homestic $ 10.00
Date:' Lf>
Industrial/Commercial $ 100.00 j N/C
Applicant
PERMIT TO DRILL A WELL
The above application_ has been approved and permission is granted to drill a well for the
following use at ` —1
%� ctr�ka��_�r
Domestic Potable (for household use)
-4bomestic Auxiliary (for watering, poo' , atc.)
_Industrial/Commercial Potable (for human consumption, including food processing)
_IndustriaUCommercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the b
usi ess of agriculture)
Date: i'V j Approved by:
nr tM Rnoril nFT-TadlrL.
NOTE: Electrical permit required; underground cable trench must be inspected