HomeMy WebLinkAboutOld North Tr. #66 - 4/7/1998MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Namei�l�
Location
Registered
Well Driller
TYPE OF WELL:
omestic Potable (for household use)
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: D1romeeysstic $ 10.00 _lndustrial/Commercial S 100.00 N/C Agricultural
Date: //7, 99 Applicant Signature:
PERMIT TO DRILL A WELL
The above application as been ap roved an,d permission is granted to drill a well for the
following use at �t �C l� /CIO iC'iJ" (�
Qomestic Potable (for household use)
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 busi erns of agriculture)
Date: 4 Approved by: `%C//' — IJ 4,
For the Board of Health
NOTE: Electrical permit required; underground cable trench must be inspeeterL
Upon installation of well, call Department of Public Works office at
26.1-7331 to be added to well list