HomeMy WebLinkAboutJefferson Rd. #4 - 9/2/1997APPLICATION FOR PERMIT TO DRILL WELL
C7;1"
Location
Installer
Address
TYPE OF WELL:
ehi jM4- c-)Cfr
_Domestic Potable (for household use)
.omestic 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 —Industrial/Commercial $ 49.00 N/C Agricultural
Date: ( Applicant Signature U'la
PERMIT TO DRILL A WELL
The above application has be ,n approved and permissi9� is granted to drill a well for the
following use at '-
Domestic Potable (for household use)
Domestic Auxiliary (for watering, pools, ew.)
_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: t � Approved by:
Foifthe Apard of Health
NOTE. Electrical permit required, underground cable trench must be inspected