HomeMy WebLinkAboutRiverside Dr. #49 - 8/20/1997APPLICATION FOR PERMrr TO DRILL WELL
\--, Name i c
Address
Location
Installer —
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:
Domestic $ 10.00
Industrial/Commercial
$ 100.00
Agricultural
Date:'
4'i
Applicant Signature:kiC,j,-j
t
//��N/C
C,xt Js9",
PERMIT TO DRILL A WELL
The above application/liasbePTapproved and perm sion is granted to drill a well for the
following use at
_Domestic Potable (for household use) _
amestic Auxiliary (for watering, pools, etc. j
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: r a Approved by:
For Board of Health
NOTE. Electrical permit required, underground cable trench must be inspected