HomeMy WebLinkAboutMarie Dr. #3 6/7/2018Commonwealth ofMassachusetts
Town of Mansfield
Board of Health
Application for Permit to Drill Well
NAME OF OWNER:
ADDRESS OF OWNER: '
TOWN/STATE/ZIP:
TELEPHONE No: 1`p, �9 5 _ /cv
Town of Mansfield
6 Park Row
Mansfield, MA 02048
REGISTERED f✓C'r 6,4
WELL DRILLER:
MALIC#: �Xc
BUSINESS
ADDRESS:
TYPE OF WELL: 11 Domestic Potable (for household use)
®!DomesticAuxiliary(forwatering,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: Chi Domestic$75.00
DATE:
Industrial/Commercial$75.00
APPLICANT SIGNATURE
Permit to Drill Well
C Agricultural $75.00
The above application has been approved and permission is granted to drill a well for the following use
Domestic Potable (for household use)
Domestic Auxiliary (for watering, pools, etc.)
Industrial/Commercial Potable (for human consumption, including food processing )
I Industrial/Commercial Auxiliary (for manufacturing, etc.)
El Agricultural (for irrigation of land in the business of agriculture)
DATE: LRe APPROVED BY 0
Fort Board of Health
NOTE., Electrical permit required; underground cable trench must be inspected.
Upon installation of well, call Department of Public Works at
508-261-7330 to schedule an inspection.
FOR WALSH BROTHERS BUILDING, CO.
11 SADDLE WAY
WALPOLE, MA 02061
508..668.3434
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2
L=J5.61'
LDS
561,
R=1J500'
C
O
\ ,q Po. 290'
\' 1
LOT 13
27,291 ± sf
LOT 18
24,074± sf
)Boy Colony Group, Inc.
Professional Civil Engineers &
Professional Land Surveyors
MqR sm�
I s
FAR
sg T,o.
S6F
MOO,
LOT 14
>so, 23,787± sf
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9q•SS f
FOUNDA TION AS —BOIL T
PLAN OF LAND FOR
(LOT 13) #3 MARIE DRIVE
MANSFIELD, MA
'W U °qss y DEC. 8, 2017 SCALE 1" = 30'
RICH a BAY COLONY GROUP, INC.
E PROFESSIONAL CIVIL ENGINEERS & LAND SURVEYORS
U N ff 4 FOUR SCHOOL STREET P.O. BOX 9135
C C FOXBOROUGH, MA 02035
c, (505) 543-J939
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I hereby certify to the Monslield Building Chermissloner Chet to the besl of my profess/onol knowledge.
Infermotien, and belief the( the dwelling is loceled on the ground as shown hereon end that it complies
with the selbock retirements of the Zoning By -Caws of the Town of Monsb'eld
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