HomeMy WebLinkAboutOld North Tr. #70 - 6/30/1997MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name�((�
Address 0._)2bk Wdltt
-
Location l �a "Yu
Installer
Addres
TYPE OF WELL:
_Domestic 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: _Domestic $ 10.00 _IndustriaVCommercial $ 100.00 N/C Agricultural
Date: LQ.� ���i Applicant Signature)__-'tCj44)
PERMIT TO DRILL A WELL
The above application has been
following use at % 0
Domestic Potable (for househc' : use)
,ion is granted to drill a well for the
TCAI C_
\j Domestic Auxiliary (for watering, tools, etc.)
_IndustrialCommercial Potable (for human consumption, including food processing)
—Industrial/Commercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
Date: kg 30C Approved by:
For the Board of He Ith
NOTE: Electrical permit required; underground cable trench must be inspected