HomeMy WebLinkAboutJefferson Rd. #7 - 12/10/1997MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name
Addres
Location
Installer
Address
yf -
TYPE OF WELL: ° I�
Domestic Potable (for household use)
:Domestic Auxiliary (for watering, pools, etc.)g�g+'
IndustriaUCommercial Potable (for human consumptions "ic d processing)
_IndustriaUCommercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
Fee: _Domestic $ 10.00 Industrial/Commercial $ 100.00 N/C Agricultural
Date: Applicant Signature.
PERMIT TO DRILL A WELL
The above application has been approved
following use at % FCZS&
is granted to drill a well for the
Domestic Potable (for household use)
De -Domestic Auxiliary (for watering, pools, etc.)
IndustriaUCommercial Potable (for human consumption, including food processing)
_IndustriaUCommercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
Date: , Approved by:
r the Board of Health
NOTE: Electrical permit required, underground cable trench must be inspected