HomeMy WebLinkAboutSouth Main St. #55 - 9/24/19971 1 1 ,I DVA 911 C
APPLICATION FOR PERMIT TO DRILL WELL
Name
►®
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: LDomestic $ 10.00 Industrial/Commercial $ 100.00 N/C Agricultural
Date: " �' 7 6Applicant Signature:
The above application has
following use at 5S
and permission is granted to drill a well for the
_Domestic Potable (for household use) Y
omestic Auxiliary for-�- �cp ary ( �tering, pools, eic.)
_Industrial/Comme--'al Potable (for human consumption, including fb: — processing)
—Ind»striaMornmerciai Auxiliary (for manufacturing, em )
_Agricultural (for irrigation of land in the busf agriculture)
Date:_ ' '14 r �! Approved
of Health
NOTE: Electrical permit required; underground cable trench must be inspected