HomeMy WebLinkAboutBasin St. #8 - 7/9/1997I DO
APPLICATION FOR PERMIT TO DRILL WELL
Name �__-_�k_✓ �� ��t°/2
Location Nir;.vi 5 ,' C /CL
Installer
r
TYPE OF WELL:
0
�D mestic Potable (for household use)
mestic 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: �omestic $ 10.00
� M -
The above application
following use at _
Applicant
and
$ 100.00 , N/C Agricultural
is granted to drill a well
Domestic Potable (for househc'. use)
I/bomestic Auxiliaryfor watering,
( g, 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)
Date: Approved by: & e &1 ,,—
For the Board of Health
NOTE: Electrical permit required, underground cable trench must be inspected