HomeMy WebLinkAboutSouth Main St. #133 - 9/9/2005./2005 THc 8:36 FAX fd02/002
MANSFIELD BOARD OF HEALTH
j APPLICATION FOR PRRMJT TO DRILL WELL
Name Lyfoj A)-� v2 L% f,s
Address: �► 3 J Sb r } 4 M%) —Telephone
Location: &'H m o -T}- ,
Registered
Well Driller:
�t �I�V�itA �i4Cpf'6rALic# ?�oinit wtLL
Address: Rr fZ t t'N r} _ CU -I (P L'___
TYPE OF WELL:
Domestic Potable (for household use)
�K Domestic Auxiliary (for watering, pools, etc.)
Industrial/Commercial Potable (for human consumption, including food processing)
lndustrial/Commercial Auxiliary (for manufacturing, etc.)
_ Agricultural (for irrigation of) and in the business of agriculture)
Fee: V Domestic $10.00 __ lndustrial/Commercial $100.00 N/C Agricultural
Date: �T Applicant Signaturebi/w iut
The above applicationas been approved and permission is granted to drill a well for the
following use at
_ Domestic Potable (for household use)
—+�omestic Auxiliary (for watering, pools, etc.)
Industrial/Commercial Potable (for human consumption, including food processing)
Industrial/Commercial Auxi Uw (for manufacturing, etc.)
Agricultural (for irrigation of land in the business of agriculture)
Date: - �I�® Approved by:
For the Board of Health
\ NOTE: Electrical permit required; underground cable trench mast be inspected.
'V\ Upon Installation of well, call Department of Public Works gffice at Y
,� 261-7330 to be added to will list. '��
e
I:,CAiKKJ �SJ SO
MORTGAGE INSPECTION PLAN ROAM DATE:
/t✓ �Y1r N t„ _ � j� 3 �l3W
�ld�u r6ie i .
Doud recorded in ly f jJ yid Registry of Doeda, Book 2a L�
And being shown as Lot A.11.1 on a plan by 411A
Dated and recorded in Book
This inspection plan was not comipiled from an Instrument survey and is not intendod to be recorded. Under no
circumstances are offsets to be used for establishing property lines or for construction purposes of any type.
Location of the structures as shown hereon either were in compliance with the local zoning by-laws in effect when
constructed (with respect to stru&ural setback requirements only), or were exempt from violation enforcement action
under Mass. G.L., title VII, ChapLor 40A, Section 7,
Location of dwelling as shown hereon does not lie within the Flood Hazard Zone on F.E.M.A. Community Map
rlo. L rQ'Qr7 A , Flood Hazard Zone has been determined by scale and is not necessarily accurate.
Accurate determination cannot be, made unless a vertical control survey Is performed,
DESIMONE SURVEY SERVICE, INC. 38 Coffee Street Medway, MA 02038
Page p
Page