HomeMy WebLinkAboutOld North Tr. #59 - 6/30/1997MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name
Address
Installer_
TYPE OF WELL:
omestic Potable (for household use)
Domestic Auxiliary (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)
Fee: V Domestic $ 10.00 IndustriaUCommercial $ 100.00 N/C Agricultural
Date:
The above application
following use at
Applicant Signature:
PERMIT TO DRILL A WELL
is granted to drill a well for the
Domestic Potable (for househo' ' ease)
T�omestic 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: dQ 3U �0 Approved by: _, i *�f LL44r
For the Board of Health
NOTE: Electrical permit required, underground cable trench must be inspected