HomeMy WebLinkAboutOakland St. #245 - 7/11/2000MANSFIELD BOARD OF HEALTH
n p ,nn APPLICATION FOR PER2MITT TO DRILL WELL
Name (!/�v �j L rl _U M (
Address�Telephone �/' ,ytt C� 3 �L 3� `
Registered Well Driller RWD Number Li?�st i L
Address a tJ ELJ C 4 i� tJ '� (� 3 j
TYPE OF WELL:
_Domestic Potable (for human consumption)
_Domestic Auxiliary (for landscape watering, pools, etc.)
Industrial/Commercial Potable (for human consumption, ' uding food processing)
VIndustrial/Commercial Auxiliary (for manufacturing, e
_Agri ral (for irrigation of land in the business of a .
Fee: Domestic $ 10.00 Industrial/Commer al $ 10 .00; >V/C Agricultural
Date: - I_I_- 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 N4 I tOil � L LU 01166C & , ) `,5 O�C4W3' L- 1 e
_Domestic Potable (for human consumption)
omestic Auxiliary (for landscape watering, pools, etc.)
industrial/Commercial Potable (for human consumptKim, including food processing)
—Industrial/Commercial Auxiliary (for manufac g, etc.
_Agricultural (for irrigation of land in the bus' ss of a cu ture
Date: 6b Approved by:
For the tokd of Health
Follow-up notes for after the well is drilled:
1. Electrical permit required, underground cable trench must be inspected.
2. Upon installation of well, call Department of Public Works office at 261-7331 to be
added to well list
3. Display "Well Water" sign.