HomeMy WebLinkAboutPilgrim Rd. #15 - 9/10/19971 11 1 1M CI CI
APPLICATION FOR PERMIT TO DRILL WELL
YName f
X Address � J5_
Location
Installer
Address
TYPE OF WELL:
_Domestic Potable (for household use)
_Domestic Auxiliary (for watering, pools, etc.)
—Industrial/Commercial Potable (for human consumption, including food processing)
Inds ' ommer ' Auxiliary (for manufachuing, etc.)
_Agncultural (for do f land in the business of agriculture)
Fee: Domestic $ 10.00 IndustriaUCommercial $ 100.00 N/C Agricultural
,Applicant Signature:
The above application napprove d permission is granted to drill a well for the
following use at o�
Domestic Potable (for household use)
OZP,nestic Auxiliaryfor watering,Z`.._
—Industrial/Commercial Potable (forhumanconsumption, including food processing)
_Industrial/Commercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
Date: I Approved by:
F13r Board of Health
NOTE. Electrical permit required, underground cable trench must be inspected