HomeMy WebLinkAboutLongwood Cir. #6 - 7/16/1997MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
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.)
_Agricuul/ltural (for irrigation of land in the business of agriculture)
Fee: 'Domestic $ 10.00 _Industrial/Commeer�rciial //$ 100.00 N/C AgricuItur I
Date: t VApplicant Signature./ —
PERMIT TO DRILL A WELL
The above application has
following use at 61
and permission is granted to drill a well for the
v av�_ L
Domestic Potable (`-- household use)
domestic Auxiliary (for watering, pools, etc.)
_IndustriaVCommercial Potable (for human consumption, including food processing)
_IndustriaVCommercial Auxiliary (for manufacturing, etc.)
Agricultural (for irrigation of land in the business of agriculture)
Date: Approved by:
For the aid of Ifealth
NOTE: Electrical permit required, underground cable trench;must,<be inspected