HomeMy WebLinkAboutMeadow Ln. #17 - 11/6/2001MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name 'Mc_
Address
Location'
Registered -
Well Driller
";/ r _
TYPE OF WELL:
Domestic Potable (for household use)
ly
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: Domestic $ 10.00 _Industrial/Commercial 10 .00 RC Agricultural
Date: �J2 _ 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 [ `7`—
_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)
Date: Approved by: ^--
Fdr`t Board of Health
NOTE: Electrical permit required; underground cable trench must be inspecterL
Upon installation of well, call Department of Public Works office at
261-7331 to be added to well list.