HomeMy WebLinkAboutWilliams St. #466 - 8/5/1997MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name
Address ZZ e, L d l 2 L 1 '/9 M� ILL-2 L
TYPE OF WELL:
-'omestic 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 9f agriculture)
Fee: _Domestic-$ 1„0.00 —Industrial/Commercial $ 100.00 N/C Agricultural
Date: ,a E:& r: , lei Applicant Signature:! i
PERMIT TO DRILL A WELL
The above application has ee{j approved anerm ssft is granted to drill a well for the
following use at � �11.1I,1 A , _ i" :
v
Domestic Potable (for household use) _
+a,,� .aestic Auxiliary (for watering, pools, etc.!
__Industrial/Commercial Potable (for human censumption, including food processing)
—Industrial/Commercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
Date: S Approved by:
or the Board of Health
NOTE: Electrical permit required; underground cable trench must be inspected