HomeMy WebLinkAboutJameson Ct. #19 - 4/21/1998MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name
Address /Ci _ P,1 LLC1 � 'C' t 12-1—
Location S�CC✓I�%
Registered
Well Driller �I=i-AtE L L/FC `
TYPE OF WELL:
omestic Potable (for household use)
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 —industrial/Commercial $ 100.00 N Agricultural
a�
Date: Applicant Signature. l� , _ ? i Cw.
I ,
PERMIT TO DRILL A WELL
The above application has be appry�ofv_ed and permission}' granted o drill a well for the
following use at 17 ja Wt P S O n
mestic Potable (for iwusehoid use)
_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)
Date: �q V Approved by: _
> the Board of Health
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.
7 Wq 6 C k .