HomeMy WebLinkAboutPratt St. #99 - 3/29/2002MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name
Address:
Location:
Registered
Well Driller:
Address: _
TYPE OF WELL:
S%
L-
V 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 $100.00 N/C Agricultural
Date: 3 `i U Applicant -Signature: ti �; �fl —
PERMIT TODRILLWELL
The above application h4s been roved and permission is granted to drill a well for the
followinguse at e- —/ q-'� j Z_-T—
_ Domestic Potable (for household use)
t/ Domestic Auxiliary (for watering, pools, etc.)
Industrial/Commercial Potable (for human consumption, including food processing)
_ Industrial/Commercial Auxiliary (for manufacturing; e1c.)
_ Agricultural (for irrigation of land in the b mess a iculture) .
Date: � ` Z� / —�y Approved by:
For e 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