HomeMy WebLinkAboutOld North Tr. #63 - 7/23/1997MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name
Address (o3 0) CUY1nY-AYULV-nt
Location 2
Installers
Address
TYPE OF WELL:
mestic Potable (for household use)
_Domestic Auxiliary (for watering, pools, etc.)
_IndustriaVCommercial 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 N/C Agricultural
Date: 7- a 3 " j_� Applicant Signature: c30vvvl VC J
PERMIT TO DRILL A WELL
The above application has been approved andpermission is granted to drill a well for the
following use at (,P3 OL/) NC(C% 7KAI(_
Domestic Potable (for household,---.)
'Domestic Auxiliary (for watering, pools, etc.)
_IndustriaVCommercial Potable (for human consumption, including food processing)
_IndustriaVCommercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
Date: %_ a 3-q
Approved by: se�)ff-z-�"le—
For the Board of Health
NOTE. Electrical permit required; underground cable trench must be inspected