HomeMy WebLinkAboutKing Arthur Way #55 - 5/18/1998MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name
Registered Well Driller
TYPE OF WELL:
D mestic 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 business of agriculture)
Fee: i✓ Domestic $ 10�.00
Date: -�
Industrial/Commercial $ 1
Applicant Signature:
PERMIT TO DRILL A WELL
N/C Agricultural
The above application has been approv@d and permission is granted to drill a well for the
following use at AZ�04tl'LrZ_
Do�mestic Potable (for human consumption)
L'Tiomestic Auxiliary (for landscape watering, pools, etc.)
_Industrial/Commercial Potable (for human consumption, including food processing)
—Industrial/Commercial Auxiliary (for man g, etc.)
_Agricultural (for irfriiggation of land in the b e s r f agriculture)
Date: f �i-�} 5 Approved by:
Fo he`BpardofHealth
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.