HomeMy WebLinkAboutOakland St. #411 - 6/18/1999MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name L r Y1 � vy -1 r h C rcc
-
Location Gy V p
Registered
Well Driller C I f /`j
Address
TYPE OF WELL:
_Dgm6stic Potable (for household use)
omestic 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:
61/,F1Q 1,q
Applicant Signature: A
l
PERMIT TO DRILL A WELL
The above application has been approved and pe issiRm }s�granted to drill a well for the
following use at Lk f ( 7
''D
�D�f�i�estic Potable (for household use)
omestic 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 busi of g 'culture)
Date: Approved by:
For th .B d of Health
NOTE: Electrical permit required, underground cable trench must be inspected
Upon installation of well, call Department of Public Works office at
261-7331 to be added to well list.