HomeMy WebLinkAboutRIverside Dr. #37 - 4/24/2000Name
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MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
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Registered
Well Driller
Address
TYPE OF WELL:
Domestic Potable (for household use)
Domestic Auxiliary (for watering, pools, ex.) do including food processing)
Industrial/Coman mercial Potable (for humconsume n,
_IndustriallCornmercial Auxiliary, (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
Fee: V Domestic $ 10.00 IndustriaUCommercial ? 1 0.00 NIC Agr%cul f al
Date: /z� Applicant Si�rature:
PERMIT TO DRILL A WELL
ermiss on is granted to drill a well for the
The above application has been �pproved �
following use at E� d
Domestic Potable (for household use)
omestic Auxiliary (for watering, pools, etc.)
Industrial/Cornmercial Potable (for human consumption, including food processing)
Industrial/Commercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
c F ��-QC� Approvedby:
Date: For the Board of Health
NOTE. permit required; undersround cable trench must be inspected
artm tit of Public Works office at
Upon installation of well, call Dee
261-7331 to be added to well list <eV