HomeMy WebLinkAboutOld North Tr. #67 - 2/20/1998MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
NameN•p�piti�q�we
Address 6-7- old W Tati
Location
Installer
Address
TYPE OF WELL:
omestic Potable (for household use)
Domestic Auxiliary (for watering, pools, etc.)
_IndustriaUCommercial Potable (for human consumption, including food processing)
—Industrial/Commercial Auxiliary (for manufacturing, etc.)
_Agric Rural (for irrigation of land in the business of agriculture)
Fee: ✓%Domestic $ 10.00 _Industrial/Commercial $ 100.00 ANIC 7 Agri uItural
Date: Applicant Signature:
PERMIT TO DRILL A WELL
The above application has been approved and permission is granted to drill a well for the
following use at (o7 (j c b No KTl f I Y-4i t
Do�mestic Potable (for household use)
i/Domestic Auxi!q,-y (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)
Date: a ^U 'q6 Approved by:
'&�� L-P-4-le 6t�
For the Board of Health
NOTE. Electrical permit required; underground cable trench must be inspected