HomeMy WebLinkAboutJameson Ct. #15 - 7/16/1997MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name M 4 kb A
Address
Location
Installer
TYPE OF WELL:
Domestic Potable (for household use)
Domestic Auxiliary (for watering, pools, etc.)
_IndustrialCommercial 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/C Agricultural
Date: `y� (i q� Applicant Signature:—kll Z ' /
PERMIT TO DRILL A WELL
The above application has bee approved and permis on is granted to drill a well for the
following use at `� t!}y, p ,� , u U [.( r-�
_Dome^t?o Potable (for household use)
E/6omestic 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: ho i / ;4proved by: A& /f ' .:& /W t_
For the Board of Health
NOTE. Electrical permit required; underground cable trench must be inspected