HomeMy WebLinkAboutPratt St. #208 - 8/2/1999MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name bA ✓1 h ,M, Al LUSS-IVV ,(� 1
69
Location
Registered
Well Driller l'il//v',Ao J _,� ✓aV' =' �Pii✓KG�+c �• /iyC ,
Address 72c>c� va✓C��'T Si /y�A Ste/
TYPE OF WELL:
omestic 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: V Domestl $ 10.00 _Industrial/Commercial $ 100.00 N/C Agricultural
Date: 8' L2-1 9 el Applicant Signature: "n,— V.21,
PERMIT TO DRILL A WELL
The above application has be pproved and permission is granted to drill a well for the
following use at
D$Xnestic 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 b mess o agriculture)
Date: a Approved by:
r t Board of Health
NOTE: Electrical permit required; underground cable trench must be inspected
Upon installation of well, call Department of Public Works office at
261-7331 to be added to well list.