HomeMy WebLinkAboutWell New 45 Newberry Road CPR-8 Rev.7/95 PERMIT NUMBER
STATE OF CONNECTICUT 249624
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION
WELL DRILLING PERMIT
165 Capitol Avenue,Hartford,Connecticut 06106
LOCATION OF WELL (Town) (Street) (Lot Nu DATE
OWNER OF WELL
IM INDIVIDUAL El BUILDER El OTHER(Specify)
OWNER'S ADDRESS
r
Est.No.of
PROPOSED DOMESTIC BUSINESS FARM TEST People being
USE OF ESTABLISHMENT �I—�TC1� WEtt G�t� served.
WELL
PUBLIC OTHER
SUPPLY INDUSTRIAL AIRCONDITIONING (Specify) C
SKETCH OF WELL LOCATION
Locate well with respect to at least two roads,showing distance from intersection and front 9f lot
location of lot to at least two roads Well location on to and to use(if present)
0
Indicate North
CR
�
Well A �
C
m
l 3
5- 7 x
a in <T /
Approximate number of feet from well to ��
nearest source of possible contamination:
The undersigned is aware that upon completion of the well, a"Well Completion Report"containing construction details and information required under
Section 25-131 of the 1969 Supplement to the General Statutes must be sent to the owner, the Department of Consumer Protection and the Water
Resources Commission on the form provided by aggncy. This e�its-t►ot vaIidl etil'aJI in r�atidn IS filled in and it has been counter-signed by
the D'ector of Health or his age n . rJJ//'� r e GG! !T 1 "
A ANT(Sign J} �� ,�PpL�AN�T'Si R�S� �IL)�M l REGISTRATION NO.
BBYYy(Tow
n elalth Officer or Agent) 4►ll DATE
PPROVED REJECTED /'
REMARKS - -
DIRECTOR OF HEALTH