HomeMy WebLinkAboutOld North Tr. #38 - 6/30/1997MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERWr TO DRILL WELL
Namer� D_P_ V eCC I D
Address 3 & C) I � NO f` k TCCAJ
Locatioh
Installer
Address
TYPE OF WELL:
omestic Potable (for household use)
Domestic Auxiliary (for watering, pools, etc.)
_IndustriaUCommercial Potable (for human consumption, including food processing)
—Industrial/Commercial Auxiliary (for manufacturing, etc.)
Agricu ral (for irrigation of land in the business of agriculture)
Fee: _Domestic $ 10.00
Date:
_IndustriaUCommercial $ 100.00 N/C Agricultural
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
�! Domestic Potable (for househc' . use)
+Domestic Auxiliary (for watering, pools, eic.)
_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: — Approved by:
Board of Health
NOTE. Electrical permit required, underground cable trench must be inspected