HomeMy WebLinkAboutOld North Trail #62 - 4/9/1998MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name )i✓, :7-2, {`-� , '=; J
Address 6, 2' OL
Location H,,' ✓' r'1 L n . / 7' G'„Lc) v-,'
Registered
Well Driller �.� :C,9✓rLL L
Address " r-
TYPE OF WELL:
-
/\
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: i� Domestic $ 10.00 Industrial/Commercial $ 100.00 N/C ricultural
D .te: ' r1 _ Applicant Signature: �G -
PERMIT TO DRILL A WELL
The above application has -en approved and permission is granted to drill a well for the
following use at __et,�2f -ice A—rMJ�d 71692, (_
omestic Potable (for household use)
Domestic Auxiliary (for watering, pools, etc.)
__Industrial/Commercial Potable (for human consumption, including food processing)
—industrial/Commercial Auxiliary (for In factu ' g, etc.)
e bu _Agricultural (for irrigation of land in ths' a of agriculture)
Date:. Approved by: _((
r the Board of Health
NOTE. Electrical permit required, underground cable,t'rencls imist'be"ifispected.
Upon installation of well, call Department o ,,Public. Works office at
261-7331 to be added to well list.