HomeMy WebLinkAboutWell New 295 Oakland Road TOWN OF SOUTH'WINDSOR
O South Windsor, Conn.
27
Date
W, LL DRILLERS PERM
. .................................. .... ....
................................. ............................. of the 11 of................
...........f..� firm .................. ... ....... ........ ................
...........
k:.... ...................... .. .. ........AV..... (address) ....................hereby 8 a IV' at (-,,v
e) am (are) a well driller d .................... ... ...... . ....... ......
"_c ....................................
ly and currently registered wit State' o necticut Water Resources
Commission and do make application herewith fora Well Driller's Permit in accordance Of the 1963 Session of the C ti rdance with e provisions of Public Act 187
i ec 'cut Legislature, fW a Well to be drilled on the property of:
Name Of Property owner:.......�"
.................. ..........
Address Of Property Owne r ..........*............. ...... .......................................
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............* ............*....... .......................... ................
Address Of Premises on which well is located:...........
The approximate location of the well will be as ............. ...... ......... ............................................................................................
The undersignedshown on the reverse si thi permit.
. is aware that upon completion of this well the above e iio�
under ve eat Ogether with a well log of information required
(c) and (d) Of Public Act 187 of the 1963 Session must be sent to: Water Resources Commission, 223 State O:ffi,,
Building,Hartford, Connecticut on the form entitled "Well completj
104-F-vort"which has been sup 111dtoregister drillers.
k,De
...............
. .... ...............
This ...........................
Permit is issued for a well located as shown to the above named well drillerApp icant
in accor4a4�ce with the Provisions of
Public Act 187 of the
1963 Session Of the Connecticut Legislatur�thi a of ..... .............
WHITE—ISSUING AGENT If - I
................
GREEN—APPLICANT . ....... LIJU
PINK—LOCAL HEALTH OFFICER 7n
CANARY—WATER RESOURCES COMMISSION B * g Offi To'r'To n,Cie, ............. ............
(Over) N
a
Locationof Well: Town of..................................................................................................................
SKETCII SHOWING LOCATION OF PREMISES IN TOWN
(Show distance and direction from road intersection or other landmark)
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Diagram Showing Lotion of Well oit 'remises:
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Route Directions for Reaching Well Site from Nearest City or Village Center: