HomeMy WebLinkAboutOld North Tr. #42 - 3/4/1998MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name
Location_�v r
Installe) N t
Address
TYPE OF WELL:
Domestic Potable (for household use)
Domestic Auxiliary (for watering, pools, etc.)
_Industrial/Commercial Potable (for human consumption, including food processing)
_IndustriaUCommercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
Fee: /Domestic $ 10.00
Date: ;3--y -9 Applicant S
PERMIT TO DRILL A WELL
The above application has been
following use at _ 4a
is granted to drill a well for the
D mestic Potable (for household use)
mestic Auxiiiaryy (for watering, pools, etc.)
_IndustriaUCommercial Potable (for human consumption, including food processing)
_IndustriaUCommercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
`- of Date: d Approved by:
For the Board of Health
NOTE: Electrical permit required; underground cable trench must be inspecterd