HomeMy WebLinkAboutRiverside Dr. #16 - 4/1/1997MANSFIELD BOARD- OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name /4-1 i ti
ripe— U,Pi
Installer
TYPE OF WELL: IU I JUL
_Domestic Potable (for household use) lTOid OF MANSFiEf I� I
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: ��� 9 Applicant
PERMIT TO DRILL A WELL
The above application has been proved and permission is granted to drill a well for the
following use at /0 lei ✓&117-13 14-0- V 2
Domestic Potable (for 1• msehold 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: �� `—`—LL Approved by: SCOff de^
For the Board of Health
NOTE: Electrical permit required; undergrouiiiVcable trench musi Ile inspected