HomeMy WebLinkAboutOld Stable Dr. #25 - 7/1/1997MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name -- (', T z4W 6
Address
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Location
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Installer
TYPE OF WELL:
Do�mestic Potable (for household use)
7 omestic 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 $ 100.00
_ IN//'C Agricultural
Date: 4_L�7- -Cj Applicant Signature:.
PERMIT TO DRILL A WELL
The above application has been
following use at cC. S i
is granted to drill a well for the
Domestic Potable (for househe'.:i use) —
wDomestic 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: Approved by:
For the Board of Health
NOTE. Electrical permit required, underground cable trench must be inspected