HomeMy WebLinkAboutStratton Rd. #7 - 4/10/2006MANSFIELD BOARD OF HEALTH -
APPLICATION FOR PERMIT TO DRIL� WELL
APR 1 8 M06
Name
Address:
Location:
z r .}
Registered
Well Driller:
Address:
TYPE OF WELL:
MA Lie #
Domestic Potable (for household use)
Domestic Auxiliary (for watering, pools, etc.)
Industrial/Commercial Potable (for human consumption, including food processing)
Industrial/Commereial Auxiliary (for manufacturing, etc.)
_-Agricultural (for irrigation of land in the business of agriculture)
Fee: L�---rpomestio $10.00 _ Industrial/Commercial $100.00 NIC Agricultural
Date: 'st. W_ e-,%°L1APplicant Signature:
PERMIT TO DRILL WELL
The above application has
following use at
approved and permission 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)
_ Industiial/Commercial Auxiliary (form a. tuning' etc.)
Agricultural (for irrigation of land in th business of agriculture)
Date: w �. I `?-tZ �, Approved by: �t'`,.,
Or 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
261-7330 to be added to well list: