HomeMy WebLinkAboutMarshall Ave. #67 - 6/15/2016APPLICATION FOR PERMIT TO DRILL WELL
Name �-Jnk a j WC
Address: Cv-� V i c. r&N 6 ( A v -p Telephone
Location:
Registered
Well Driller: �0 V✓� T(n) h MA Lie # D
Address: & /A K) ck,c'a-VG.,� a-t- !i l�A) C.'F_ (
TYPE OF WELL3� I Gw L1t rev Y P{ , I �w VS bv� y N I
Domestic Potable (for household use)
Domestic 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: J Domestic $75.00 Industrial/Commerciial $75.00 Agricultural $75.00
Date: Applicant Signature: &
The above application has been approved and permission is granted to drill a well for the
following use at Jgj WA2SOAe...
-Domestic Potable (for household use)
Domestic 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 busirrlgss of agriculture)
Date: 'Tvk - Approved b _ imIAKyIA
or the Board of Health
NOTE: Electrical permit required, underground cable trench must be inspected
Upon Installation of well, call Department of Public Works ofe�tt Hra�a:ll y
261- 733 0 to be added to well list.