HomeMy WebLinkAboutVilla St. #1 - 7/9/1997APPLICATION FOR PERMIT TO DRILL WELL
Name
Location_ \ \1 '\�
Address l aC (l \g ®c,� �j�C M 'At
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: CA Applicant Signature:
PERMIT TO DRILL A WELL
The above application has b9en approved and permission is granted to drill a well for the
following use at
Domestic Potable (for househc':i 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)
Date: Approved by:
Forbe a Board of Health
NOTE. Electrical permit required, underground cable trench must be inspected