HomeMy WebLinkAboutLongwood Cir. #18 - 7/30/1997MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name
Address
Location
Installer
TYPE OF WELL:
_Domestic Potable (for household use)
lZbomestic Auxiliary (for 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: Domestic $ 10.00
Industrial/Commercial
$ 100.00
N/C Agricultural
Date:
Applicant Signature:
PERMIT TO DRILL A WELL
The above application has been approved and permission is granted to drill a well for the
following use at L o n g (�-V-VC C' I r� t
Domestic Potable (for household use) I. —
60mestic Auxiliary (for watering, pools, e_tc.)
_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)
Date: Approved by:, 2Wr--/-Q 4'k d
For the Board of Health
NOTE. Electrical permit required, underground cable trench must be inspected