HomeMy WebLinkAboutRIverside Dr. #41 - 4/1/1998MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name
Address
Location
Registered
Well Driller
Address
TYPE OF WELL:
_Domestic Potable (for household 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)
Fee: omestic $ 10.00 _Industrial/Commercia 100.00 C Agricultural
Date: AppL,Applicant Sign: G
PERMIT TO DRILL A WELL
The above application has beep approved and permission is granted to drill a well for the
following use at , z KurrznstAe
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 'rrigation of land in the bus' of agriculture)
Date: i Approved by:
Fo a Board of Health
NOTE: Electrical permit required, underground cable 1xenelt; ma0e mspeGSed
Upon installation of well, call Department i" hb11tE -Works office at
',l� r
261-7331 to be added to well list.