HomeMy WebLinkAboutPark Row #6 - 8/4/1997MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name low.J o �- MwNSFi1:Lc>
Address 6 2ArOc Rnvp
Location (' PAK lc Rove
Installer o� {Marts'F,ct
TYPE OF WELL:
_Domestic Potable (for household use)
TDomestic 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: Wp�stic $ 10.00 Industrial/Commercial $ 100.00 N/C Agricultural
Date: ?=0 q—i % Applicant Signature: Cam_�
PERMIT TO DRILL A WELL
The above application has been approveEi and permission is granted to drill a well for the
following use at2� n.
Domestic Potable (for household use) _ —
�Dowostic 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 busine agriculture)
Dawle Approved by:
For tfi0oard of Health
NOTE. Electrical permit required; underground cable trench must be inspected