HomeMy WebLinkAboutBrook St. #74 - 4/13/1998MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name Bf4-(-,4 Y a'l s
Address
S
Zo
Registered
Well Driller ensek We
Address
TYPE OF WELL:
,m oestic Potable (for household use)
ZDomestic 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 $ 100.00 —Industrial/Commercial $ 100.00 N/C
Date: �J 0 Applicant Signature:
PERMIT TO DRILL A WELL
The above application has beery approved and permission is granted to drill a well for the
following use at
Domestic Potable (for household use)
C/bomestic Auxiliary (for watering, pools, etc.)
_Industrial/Commercial Potable (for human consumption, including food processing)
—industrial/Commercial Auxiliary (for manufac g etc.)
Agricultural (for irrigation of land in th�businof agriculture)
Date: i _ I (1 Approved by -- �f
For the Board of Health
C%d
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.