HomeMy WebLinkAboutOld North Tr. #30 - 3/18/1998Name
MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
-•t '40191 C rct ter t/'3`i
Address ��'Ca �IGC %�DY�/J 7r—ei
Registered
Well Drill(
TYPE OF WELL:
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:
Domestic $ 10.00
—Industrial/Commercial
$ 100.00 N/C Agricultural
Date:
7" 1 �_" `C ll
Applicant Signature:
lellUe ml
PERMIT TO DRILL A WELL
The above application has been approved and permission is granted to drill a well for the
following use at X- ("'( -Tyfhfa t �'--
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: � '- t Approved by: f
VorAhe Board 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.