HomeMy WebLinkAboutOld North Tr. #71 - 6/30/1997APPLICATION FOR PERMIT TO DRILL WELL
Name
Address :7 / Q) d Now -7,r aj
Location f�p, re-) e:-
Installer
TYPE OF WELL:
_Domestic 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 $ 1,40.00 N/C
Date: C,��J/9 7 Applicant
PERMIT TO DRILL A WELL
The above application has been approved and permission is granted to drill a well for the
following use at -7 1 /i L 13 LY,q / [_
Dymestic Potable (for househc';i use) —
✓bomestic Auxiliary (:Vi 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)
Date: kf 3U I Approved by: JMLt &�_k L,
For the Board of Health
NOTE. Electrical permit required, underground cable trench must be inspected.