HomeMy WebLinkAboutRiverside Dr. #33 - 4/17/2012APPLICATION FOR PERMIT TO DRILL WELL
Name JEP6 6W77
Address: 33 Q111"!/dE ()A14 Telephone ?61 ZVI 6320
Location: AkXT 'P> 44AI66
Registered
Well Driller: AgAymir wATi/Z, IW,aa MA Lic # 71a2
Address: I bLG c Jr. hddb1o,J Ah-/ B3as'1
TYPE OF WELL:
Domestic Potable (for household use)
Domestic Auxiliary (for watering, pools, etc.) — lA Aj&4170tj
_ 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: y11yt/12' Applicant Signature: _
PERMIT TO DRILL WELL
The above applicatioulta§ be proved and permis5jon is granted to drill a well for the
following use at
_ Domestic Potable (for household use)
omestic 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 b s of agriculture)
Date:APOAA.,i LnKpproved by:
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
261-7330 to be added to well list.