HomeMy WebLinkAboutKing Arthur Way #52 - 5/6/1998MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL '" "IN OF Wfi
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Name
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TYPE OF WELL:
—Domestic Potable (for human consumption)
Domestic Auxiliary (for landscape 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: k` Domestic $ 10.00 Industrial/Commercial $ 100.00 N/C Agricultural
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Date: VV\ft q4 Applicant Signatu%:=
PERMIT TO DRILL A WELL
The above application h been approved and permission is granted to drill a well for the
following use at r/,,, ",Liy}� i az 4
Domestic Potable (for human consumption)
�mestic Auxiliary (for landscape 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 ' ass of agriculture)
Date: UAu S Approved by: the Board of Health
Follow-up notes for after the well is drilled:
1. Electrical permit required, underground cable trench must be inspected
2. Upon installation of well, call Department of Public Works office at 261-7331 to be
added to well list.
3. Display "Well Water" sign.