HomeMy WebLinkAboutJameson Ct. #2 - 3/30/1998MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name
Address e7 /,414045OAoll
Location • y�
Installer o4 ffi' JA; ,4/Z T'e_51A Al ee, - CP.
Address_ C _ �x S"!® �a O,t 1 A1.5 Q CX 7' .7 $ 5'
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: V/ Domestic $ 10.00 Industrial/Commercial $ 100.00 N/C Agricultural
Date: t 0 19 8 Applicant
PERMIT TO DRILL A WELL
The above application has been approved and permission is granted to drill a well for the
following use at % -,_ 0 i
_Domestic Potable (for household use)
C> 2Pmestic 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 busing -of agriculture)
Date: Approved by:
tithe 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.