HomeMy WebLinkAboutJameson Ct. #6 - 4/15/1998MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
501/1 flaU r�
Registered
Well Driller
TYPE OF WELL:
_Domestic 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/C Agricultural
Date:
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— �- 1 ?
Applicant Signature: h
Aii'U - jj,;IWQ
The above application
following use at
PERMIT TO DRILL A WELL
and permission is granted to drill a well for the
_Domestic Potable (for household use)
t/Domestic Auxiliary (for watering, pools, etc.)
_Industrial/Commercial Potable (for human consumption, including food processing)
—Industrial/Commercial Auxiliary (for
_Agricultural (for irrigation of land in 1
Date: q— / S - r Approved
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.