HomeMy WebLinkAboutOld Stable Dr. #16 - 7/1/1997MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name 4
Location
Address
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 Industrial/Commercial $ 100.0..00 � N/C Agricultural
Date Applicant Signature�W
PERMIT TO DRILL A WELL
The above application has been approved and
following use at I Cn &L 1T 13(
is granted to drill a well for the
_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)
Date: 1 Approved by:
r the Board of Health
NOTE: Electrical permit required; underground cable trench must be inspected