HomeMy WebLinkAboutLongwood Cir. #10 - 7/16/1997MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name 'Herb Pfe(,,j
S )0 CI c!Q
Location GCS 90))')d Norse
Pre�� L.�clsc:p,n�
PCB 6 M?-�nsielc{, MA .
TYPE OF WELL:
_Domestic Potable (for household use)
% Domestic Auxiliary (for watering, pools, etc.)
IndustriaUCommercial Potable (for human consumption, including food processing)
_IndustriaUCommercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
Fee: L-4omestic $ 10.00 _IndustriaUCommercial $ 100.00
Date: ���� / q Applicant Signatures
PERMIT TO DRILL A WELL
The above application has been approved and
following use at / _ LZ n L11AJ_
N/C Agricultural
to drill a well for the
Domestic Potable (for ho-_;sihold use)
t.;Domestic Auxiliary (for watering, pools, etc.)
_IndustriaUCommercial Potable (for human consumption, including food processing)
_IndustriaUCommercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
Date: Approved by: � l& 4o 4 k, e
For the Board of Health
NOTE: Electrical permit required; underground cable trench must be inspected