HomeMy WebLinkAboutJameson Ct. #18 - 6/27/1997MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name //�! c%
Installer
TYPE OF WELL:
Domestic Potable (for household use)
omestic 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)
Fee: Domestic $ 10.00 IndustriaUCommercial $ 100.00 N/C Agricultural
Date: -C� '7/�7 Applicant Signature: m zll) �� �t 1l�_
PERMIT TO DRILL A WELL
The above application has ben approved and pepvission is granted to drill a well for the
following use at 1_!_ur`i
Domestic Potable (for househo':_1 use)
DLDomestic 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 busine of agriculture)
Date: (1l 2 A Approved by:
For a Board of Health
NOTE: Electrical permit required; underground cable trench must be inspected