HomeMy WebLinkAboutWell New 1010 Strong Road TOWN OF ,SOVTV WINDSOR
South Winosor, Conn. �-
51
Date .. ...... ........
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L .DRILL R'S PERMIT
.,. . ................................
of the fi of.�..
.... ..............
...
(address
hereby state that I (we) am (are) a well ri er du y and currently egistered with tate of Con ticut Water Resources
Commission and do make application herewith for a W>V Driller's P it i accordance with the provisions of Public Act 187
of the 1968 Session of the Conn tic Le ' 1 ure, a well to d ll n the property of:
Name'of Property Owner:............. ,
.....
...... ...........
Address of Property Owner:..............
Address of Premises on which well is located:.......... ...
. ..... .. ....
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 196 Session must be sent to: Water Resources Co ssion, 223 State Office
Building,Hartford, Connecticut on the form entitled"Well Completio port"which has b&nsurrieh to registere fillers.
............. ....... .
Applicant
This hermit is-issued for a well located as shown to the above named well driller in accordan with the Provisions of
Public Act 187 of the 1963 Session of the Connecticut Legisla re t is.......��0.
ao ................. .. .. ................. ............196 ...
WHITE—ISSUING AGENT k
GREEN—APPLICANT ............................ ........
. .......:..................
PINK—LOCAL HEALTH OFFICER B •ld2ng Oici or Tow erk
CANARY—WATER RESOURCES COMMISSION (Over)
Location of Well: Town of.... ...�....,.. .............t...... .............. ...................................
SKETCH SHOWING LOCATION OF PREMISES IN TOWN
.(Show distance and,'direction from road intersection or other la dmark)
V
t!t
Diagram Showing Location of Well on Premises:
Route Directions for Reaching Well Site from Nearest City or Village Center: