HomeMy WebLinkAboutRumford Ave. #102 - 8/26/1997X,Name
APPLICATION FOR PERMIT TO DRILL WELL
S iD,2 PIUM kt AVC - MV34iel d
Location
Installer
Address
TYPE OF WELL:
Domestic Potable (for household use)
Domestic Auxiliary (for watering, pools, etc.)
—IndustriaYCommercial 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: ?-s Applicant Signature ( j_
PERMIT TO DRILL A WELL
The above application I has b n approved and permission is granted to drill a well for the
following use at rLr� ram_.
Domestic Potable (for household use) _
��e Domestic Auxiliary �' r watering, pools, etc.)
dustrial/Commercial Potable (for human consumption, including food processing)
—Industrial/Commercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
DateApproved by:
ForkhdBoaf&ofHealth
NOTE: Electrical permit required, underground cable trench must be inspected