HomeMy WebLinkAboutRIverside Dr. #12 - 4/4/2000MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Location �-^
Registered
Well Driller
Address '
TYPE OF WELL:
_Domestic Potable (for household use)
._k pornestic 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: .� W Applicant Signature:41ar
z
PERMIT TO DRELL A WELL
The above application has been approved and perm sioon is granted to drill a well for the
following use at z-.�---
_Domestic Potable (for household use)
_Ik-Domestic Auxiliary (for watering, pools, etc.)
Industrial/Commercial Potable (for human consi
—Industrial/Commercial Auxiliary (for manufptii
_Agricultural (for irrigation of land in the bt,(sines
L roved b
Date: A � r PP Y: For
including food processing)
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
SfF—�