HomeMy WebLinkAboutSouth Main St. #71 - 8/21/1997I 1 ;�• 101 me 1
APPLICATION FOR PERMIT TO DRILL WELL
Name
Addres
1'YFh OP WELL: aa(� �r d"
omestic 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 irrigation of land in the business of agriculture)
Fee: _Domestic $ 10.00 Industrial/Commercial $
Date: AC '�'7 — 2 Applicant
PERMIT TO DRILL A WELL
The above application has
following use at -% f
Agricultural
is granted to drill a well for the
Domestic Potable (for household use)
Domestic 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:Approved by:
For the Board of Health
NOTE. Electrical permit required, underground cable trench must be inspected