HomeMy WebLinkAboutOld North Tr. #34 - 3/18/1998MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMTT TO DRILL WELL
Name _�D/�� �� �A
s _3V O /c✓ .mot/n,�., 7'� jlZt. ,
TYPE OF WELL:.
_Domestic Potable (for household use)
X 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 NIC Agricultural
Date: - (� -'�i % Applicant Signature: /�"
PERMIT TO DRILL A WELL
The above application has been approvedand permission is granted to drill a well for the
following use at
Domestic Potable (for household use)
Vbomestic Auxiliary (for watering, pools, etc.)
_IndustriaUCommercial Potable (for human consumption, including food processing)
_Industrial/Commercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
Date: ram(` 7 Approved by:�%
For the Board of Health
NOTE. Electrical permit required; underground cable trench must he inspected