HomeMy WebLinkAboutBaybrook Farm #66 - 8/5/1997MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name GO -
-6
Location Sf7 Iyt le
TYPE OF WELL: id I AUG - 5
DomesticPotable (for household use) :N OF ;F(F__''a
Domestic 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 $ 10.00 IndustriaUCommercia//ll� $ 100.00 N/C Agricultural
Date: $ IS y i Applicant Signature: J"Wq L} ld Mag Q
PERMIT TO DRILL A WELL
The above application has bee roved and permission is granted to drill a well for the
followinguseat %(D LGCti-16gfylG
�omestic Potable (for household use) _ _-
V Domestic Auxiliary (for watering, pools, etc.)
_IndustriaUCommercial 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: JN �f k Alee
For the Board of Health
NOTE. Electrical permit required, underground cable trench must be inspected