HomeMy WebLinkAboutSouth Main St. #320 - 6/4/2003MANSFIELD 130OF HEALTH low (1
<a w-e
APPLICATION FOR PERWHT To ))RILL WELT,
Name jt'_TT jA-tA-aA/13'ffd1j
Address:. 3^ICJ S„ IvIe'.rA `.
Location: 1`AIZA— jZ1G07_ its9E- 0je0e Z-ry (
Registered
Well Driller: pL�ladd$�y
Address: c307 t C) `w���
TYPE OF WELL:
_ Domestic Potable (for household use)
L/bomestic Auxiliary (for watering, pools, etc.)
ladus1 riaVCOmmereial Potable (for human consumption, including food processing)
�Industrial/Con... at Auxiliary (for manufacturing, etc.)
Agricultural (for irrigation of land in the business of agriculture)
Fee: !Domestic $10.00
Date: � 3
Industrial/Commercial $100.00 N/C Agricultural
Applicant Signature: 6LUirr '
The above application has been approved and permi�5toa is fit ed to drill a well for the
following use at
omestic Potable (for household use)
Domestic Auxiliary (for watering, pools, etc.)
Industrial/Commercial Potable (for human consumption, including food processing)
_` Iudustrial/Commerdal Auxiliary (for manufaetu - g, etc.)
Agricultural (for irrigation of land in the bysirtess o g�iculture)
Date: C / 6 j Approved by: — `
the Board of Health
NOTE: Miectrical permit required, underground cable trench must be inspected
Upon Installation of we/4 call Department of Public Works offrce at
26I-7330 to be added to well list.
a
r
A
DENWOOD STREET
AN UNCONSTRUCTED WAY
c
LC
C,
c
r