HomeMy WebLinkAboutTanya Dr. #23 - 7/15/1997APPLICATION FOR PERMIT TO DRILL WELL
Name
Address
1/
Location
Installer
Address 5;L T- A,V CT MAN
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: ��/�i /�. /S9 7 Applicant Signature:
�* _.
PERMIT TO DRILL A WELL
The above application has been approved and �ermission is granted to drill a well for the
following use at o�3 K1 N y ')
_Domestic Potable (for househc'.: use) —
I/Somestic Auxiliary (for watering, pools, etc.)
_Industrial/Commercial Potable (for human consumption, including food processing)
—Industrial/Commercial Auxiliar,r "For fumufactunng, etc.) - --
_Agricultural (for irrigation of land in the business of agriculture)
Date: %— -G'j -] Approved by:
Fora Board of Health
NOTE: Electrical permit required, underground cable trench must be inspected