HomeMy WebLinkAboutSmith Rd. #34 - 5/28/1998Iu /:\`►f; 1 : 1 1 11 1
APPLICATION FOR PERMIT TO DRILL WELL
Name �0_e,tivvi_S UlS G.wT 1
Address 3 L , SA, 7H floc U Telephone A 61 - 13c�
Registered Well Driller 5C 4 (2 Number
TYPE OF WELL:
_Domestic Potable (for human consumption)
v Domestic Auxiliary (for landscape 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: ,V// Domestic $ 10.00—Industrial/Commercial $ 100.00 .N/C Agricultural
Date: 5 )a,f W Applicant Signature: ( )en Usk _
PERMIT TO DRILL A WELL
The above application�as een approve d permission is granted to drill a well for the
following use at �5 qj
_Domestic Potable (for human consumption)
�' Domestic Auxiliary (for landscape 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 bu ' e� of griculture)
Date: m(`n � -/ � Approved by:
or a Board of Health
Follow-up notes for after the well is drilled:
1. Electrical permit required, underground cable trench must be inspected
2. Upon installation of well, call Department of Public Works office at 261-7331 to be
added to well list
3. Display "Well Water" sign.