HomeMy WebLinkAboutRIverside Dr. #27 - 4/23/1998MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name J E,� J L yJ IV 1CAk- J1V LL ii
Address 2 k) LEE S' i DC l) k i L E
Location S 1il"1
Registered
Well Driller X'AI YLL) klgkW SZ01 LL_.P C"C')
Address
TYPE OF WELL:
_Domestic Potable (for household use)
2bomestic 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: Applicant Signature:
PERMIT TO DRILL A WELL
The above application has been appr ved and
following use at
_Domestic Potable (for household use)
i/bomestic Auxiliary (for watering, pools, etc.)
_Industrial/Commercial Potable (for human const
—Industrial/Commercial Auxiliary (for manufactu
_Agricultural (for irrigation of land in the busin s
Date: �� C Approved by: _
For
is granted to drill a well for the
including food processing)
NOTE: Electrical permit required; underground cable efich M, 14'si einspected.
Upon installation of well, call Department of Public Works office at
261-7331 to be added to well lisp