HomeMy WebLinkAbout199 Morgan Farms Drive CPR-8 Rev.7195 P[�E,RMI,�TpNUMBER
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STATE OFCONNECTICUT ''
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION
WELL DRILLING PERMIT
165 Capitol Avenue,Hartford,Connecticut,06106
LOCATION OF WELL (Town) (Street) (Lot Number) a.� DATE f
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I OWNER OF WELL
INDIVIDUAL BUILDER OTHER(Specify)
OWNER'S ADDRESS
+ r :1 77
Vt./ t,1C, t�.,.C:° Ii-,".
Est.No of
PROPOSED DOMESTIC BUSINESS FARM a TEST People being
USE OF ESTABLISHMENT WELL _L served.
WELL
PUBLIC .; INDUSTRIAL ;. AIR :% �� OTHER
SUPPLY a a CONDITIONING (specify)
SKETCH OF WELL LOCATION
Locate well with respect to:at least two roads,showing distance from intersection and front of lot
location of lot jo at least two roads Well location on to and to house(if present)
Indicate North
S_ \ y'
ky
777
r.... . :. s .) r•...; tl•(F'�f �: -` t <;r
r �r
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 the agency. This permi'tls-not.valid until all information is filled in and it has been counter-signed by
the Director of Health or his-agent.
APPLICANT(Signature) rh Y?�jft ew ' t�6 ov. (�y4PP�11:1►NT`SAflDRESS""7lr r r�;/, Q: ,�s [_ fr=6��r_u REGISTRATION NO.
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4. BWTown Health Olficer.orAgent) DATE
APPROVED ❑ REJECTED - t _ VI
REMARKS `
�s
DIRECTOR OF HEALTH