HomeMy WebLinkAboutStillbrook Ln. #6 - 5/3/2000MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name 1J6" ^ 1{ r C" V\ a„^
Address 11\`
Location 44:z
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Registered
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Well Driller _
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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 _Industrial/Commercial $$ 100.00 N/C Agricultural
Date: e57 ) 3/ O0 Applicant Signature: ----
PERMIT TO DRILL A WELL
The above application has been approved and permission is granted to drill a well for the
following use at fv S71 c. L 4,1y r ! e4N E
D mestic Potable (for household use)
mestic Auxiliary (for watering, pools, etc.)
Industrial/Commercial Potable (for human consumption, including food processing)
Industriai/Commercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the bus' n s of agriculture)
Date: S 3 - Approved by: For the Board of Health
NOTE: Electrical permit required, underground cable trench must be inspected
Upon installation of well, call Department of Public Works office at
261-7331 to be added to well list