HomeMy WebLinkAboutWell New 1005 Strong Road TOWN OF SOUTH WINDSOR
NSouth Windsor, Conn.
® 66 �f L
DateAk....091...Z.,.
WELL DRILLER'S PERMIT
.... ..... ................. . ... ...............,.:.. of the firm of.
.......... ...................
......................................
. .. ....... ...... ..
(address)
hereby state that I (we) am (are) a well driller duly and currently registered wit the too 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 Connecticut Legislature, f r a well to be drilled on the pro ert
Name of Property Owner:....
................. '. .. ....... ................................ ....L..G....�. ....5....................
...... .....:...............
..
Address of Property Owner:.�,r� .
........
Address of Premises on which well is located:......... . � Q I )�.
.�o .
The approximate location of the well will be as shown on the reverse side 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 Commission, 223 State Office
Building, Hartford, Connecticut on the form entitled"Well Comple 'o �®rt'.'which hasup to registered drill s.
........... ..........................
This permit is issued for a well located as shown to the above named well driller in accorda ce with the Provisions of
Public Act 187 of the 1963 Session of the Connecticut Legisl u his. ....
WHITE-ISSUING AGENT
GREEN-APPLICANT
PINK-LOCAL HEALTH OFFICER "' """'
ing O i ... . ....... ..... .............
D'AHARY-WATER RESOURCES COMMISSION
(Over) Bu or n erk ... ..........
Location of Well:Town of ..,,.::.. ............ ................ . . ......F ..... ... ..................
+ SKETCH SHOWING LOCATION OF PREMISES IN TOWN
(Show distance and direction from road intersection or other landmark)
Diagram Showing Location of Well on Premises:
k
Route Directions for'Reaching Well-Site from Nea t City tr Village Cent
.y