HomeMy WebLinkAboutSouth Main St. #364 - 6/30/1999APPLICATION FOR PERMIT TO DRILL WELL
Name
Address 3t t/ Si. iYi�>i✓ Sj
Location
Registered
Well Driller
TYPE OF WELL: t
Domestic Potable (for household use) s �j
_Domestic Auxiliary (for watering, pools, etc.
_Industrial/Commercial Potable (for human consumption, including fdiod prof
_Industrial/Commercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
Fee: 1LDomestic $ 10.00 —Industrial/Commercial $ 100.00 N/C Agricultural
Date: (4g� C, _ Applicant Signature �-
PERMIT TO DRILL A WELL
The above application has
following use at 121/1
and permisAign is granted to drill a well for the
_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 busin s of agriculture) gg
Date: C0 3D . " /' Approved by: �� � B �i � 'J/ X-
For the Board of Health
NOTE. Electrical permit required; underground cable trench must be inspected
pon ins Lion of well, call Department of Public Works office at
261-7331 to be added to well list