HomeMy WebLinkAboutPlantation Rd. #27 - 3/24/2000MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name
Location kl , -c
Registered
Well Driller Pa/fC- �ei:.1t �
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Address 6 � �-ra r�r�"z Si 1312< `�<`" Y t°2
TYPE OF WELL:
_Domestic Potable (for household use)
Domestic Auxiliary (for watering, pools, etc.)
_IndustriaUCommercial Potable (for human consumption, including food processing)
_Industrial/Commercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
Fee: LDomestic($ 10.00 Industrial/Commercial $ NOV`N/C Agricultural
Date: 3 — a T' 0& Applicant Signature•
PERMIT TO DRILL A WELL
The above application has been apgroved and permission is granted to drill a well for the
following use at
JL4'U rv. "� L r J
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)
Date: 3 -ci-�O Approved by:
For the 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