HomeMy WebLinkAboutWell New 00 Strong Road (2) -TOWN OF SOUTH WINDSOR
South Windsor, Conn.
74 Date 10
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WELL DRILLER'S PERMIT
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of the firm of
........................................................................................................................... (address) ............................. .........................................................................hereby.state that I (we) am (are) a well driller duly and currently r ..egistered with the State of Connecticut Water Resources
'Commission and do make application herewith for a Well Driller's Permit in accordance with the provisions of Public Act 187
Of the 1963 Session of the Connecticu gislature, fora
1 11 to be drilled o e erty of: r4
Name.,of Property Owner:...... 0
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Addre,$.s of Property Owner:.............................
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Address of Premises on which well is located: ................ ...
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The approximate location of the well will be as shown on the rever ide of this permit.
The undersigned is aware that upon completion of this well the above data,together with a well log of information required
under (c).and (d) of Public Act 187 of the 1963 Session must be sent to: Water Resources Co ission, 223 State Office
Building,'Hartford, Connecticut on the form entitled"Well Completio port" hi h S p d to register Tillers.
�eport"which ha�:�
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Applicant
This permit is issued for a well located as shown to the above named well driller in accordance with e Provisions of
Public Act 187 of the 1963 Session of the Connecticut Legislature this ?k_e. ....day of 196.X.'
WHITE—ISSUING AGENT
GREEN—APPLICANT ... .........4117_-_1%. .. . ....................................................
PINK LOCAL HEALTH OFFICER Bui
IN OX
CANARY-WATER RESOURCES COMMISSION
(Over)
t ,
Location of Well: Towne of..:.. .
SKETCH SHOWING LOCATION OF PREMISES IN TOWN
(Show distance and direction from road intersection or other landmark)
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Diagram Showing Location of Well on Premises:
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Route Directions for Reaching Well Site from Nearest City or Village Center: