HomeMy WebLinkAboutMayflower Dr. #10 - 4/4/2000, 5/19/200003/30/2000 09:15 5092617343 PAGE 01
APPLICATION FOR PERMIT TO DRILL WELL
Name �- (16tDh (' A l`IlWTTi 1\IMP'
Registered
Well Driller I Y'
5-6 $S a
TYPE OF WEid-
D9mesdc Potable (for household use)
nmestic Awtiliary (for waging pools, etc.)
—Industrial/Commercial Potable (for human consumption, including food processing)
—Industriai/Com marcial Auxiliary (for moudkcnuing, etc.)
Agricultural (for irrigation of Ind in the business of agriculture)
Fee: ✓Domestic $ 10,00 1ndustialiCommereial S 100M )K Agricultural
Dare: 1 a 61 0 Applicam
PERMIT TO DRML A WELT,
The above applica on has been approved and permission is grained to drill a well for the
following use at l ,�(✓Lt b( �� ri ? �2
Domestic Potable (for household use)
Domestic Awdliary (for arming, pools, ern)
_ IndustriaUComnaerciai Potable (for human consumption, including food processing)
Industrial/Commercial Auxiliary (for rmaufactrring etc.)
_Agricultural (for irrigation of had in the business of agriculnue)
Date: _ Cr Approved
For a Board of Ha dth
NOTE: ,E(6W*d petmd regtrLrsd, wWaVound cable wench netts be inspected
Upon installation of well, call Department of Public Works office at
261-7331 to be added to weU Ust
05/04/00 21:49 FAX 9788741549 AMERICAN DRILLIN 002
06/1S/1999 08!45 5082617343 1 PAGE 01
MANSFIELD BOARD OF HEALTIJ
APPLICATION OR PERMIT TO DRILL WELL
r
Name
Location r?" "C
Registered
WeliDriller American Drilling Services, Inc. #607
9 Hathrick Rd. / P.O. Hox353 Westminster Ma.
TYPE OF WELL:
Domestic Potable (for household use)
i Domestic Auxiliary (for watering, pools, etc.)
,�ustrial/Commercial Potable (for, human consumption, including food processing)
—industrial/Commercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
Foe: bamestic S 10,00 `Industrial/Commercial $ 100.00 NICC Agricultural
Date Applicant Signature:2% t r
PERMIT TO DRILL A WELL
The above application has been approved and permission is granted to drill a well for the +`t
foliowing use aI 14 &/�xe� �✓
Domestic Potable (for household use)
11—�Dortnestic Auxiliary (for watering, P9els, etc.)
Industrial/Commercial Potable (for human consumption, including food processing)
industrial/Commercial Auxiliary (for manufacturing, etc.)
Agricultural (for irrigation of land in.the blgt�:
agriculnre)
Date: %� i�� Approved by;
Feoard ofHealth
NOTE: Ela+edlcal perMd rsqutred; Wuk79PWmd cable trench mast be inspected
Upon installadon of well, call Department of Public Works office at
26J-7331 to be added to well MSS