HomeMy WebLinkAboutSouth Main St. #141 - 4/22/2008MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name
Address: _ 1 lk�, (:�.�h YMjA � f Telephone �5 136
Location: C SCA VV�tz�
Registered ///��� ((
Well Driller: r (ID ,1,1:P ff6MA Lic #
Address: _INcZ &5__4 "ooa4f_tr WA
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: / Domestic $10.00 _ Indi
Date: C�A I l 55 a00g Applicant
PERMIT TO DRILL WELL
The above application has been ,vproved and pe on is granted to
following use at W?V h L\t !n
Domestic Potable (for household use)
y,__ 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)
Date: / J/2�/ Approved
Board of Health
NOTE: Electrical permit required; underground cable trench must be inspected
Upon Installation of well, call Department of Public Works office at
26I-7330 to be added to well list