HomeMy WebLinkAboutLeonard St. #15 - 6/25/1997MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Named
Address�--
Location
Address
TYPE OF WELL:
Domestic Potable (for household use)
;-Domestic Auxiliary (for watering, pools, etc.)
Industrial/Commercial Potable (for human consumption, including food processing)
_IndustriaVCommercial 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., 7 Applicant Signature: 9� /I
PERMIT TO DRILL A WELL
The above application has been approved and
following use at 61
Domestic Potable -or household use) _ -
is granted to drill a well for the
V—Domestic Auxiliary (for watering, pools, etc.)
_IndustriaVCommercial Potable (for human consumption, including food processing)
—Industrial/Commercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
Date: Z'g Ci Approved by:
(:R i 1 H
NOTE: Electrical permit required; undergroril d�cable &4YWdhr,Must be inspected