HomeMy WebLinkAboutKing Arthur Way #26 - 8/6/1997MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERAUT TO DRILL WELL
Name
Address
Location
TYPE OF WELL:
N
Domestic Potable (for household use)
e' 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: Applicant
PERMIT TO DRILL A WELL
The above application h s been approved and permission is granted to drill a well for the
following use at {% _ F� (//� (,(1 �9 Nt
Domestic Potable (for household use)
Domestic Auxiliary (for wo ering, pouis, etc.)
_Industrial/Commeici;-. .. ,A`4e (for human consumption, including food profwssi„g)
_IndustriaUCommercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
Date: R-Al1-�— Approved by: c J( C� S(�C� d,
For the Board of Health
NOTE. Electrical permit required, underground cable trench must be inspected