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HomeMy WebLinkAbout702 Strong Road PERMIT NUMBER s. CPR-8 Rev.7195 � aJS +;v''_ STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION k. REAL ESTATE 81 PROFESSIONAL TRADES DIVISION WELL DRILLING PERMIT 165 Capitol Avenue,Hartford,Connecticut 06106 LOCATION QF WELL. (Town) {Srreetj (Lot nrumber) DATF� South .lindsor ;02/704 Strong 10 OWNER OF WELL .INDIVIDUAL BUILDER OTHER(Specify) OWNER'S ADDRESS Will flro c `3a Val �.?y View SR Sys: th Windsor Est.No.of PROPOSED DOMESTIC BUSINESS FARM TEST People being USE OF ESTABLISHMENT WELL served. WELL AIR 4 © `SUPPLY ` El-- tJ.STRIAI .. El CONDITIONING {Specify)" ?,yr.:.�—stvacs-•r-..i,: OTHER SKETCH OF WELL LOCATION Locate well with respect to at least two roads,showing distance from intersection and front of lot location of lot to at feast two roads Well location on to and to house(if present) Indicate North a� CS -S r 4 N , f y p,„�<em ..M+arE•,�....w._— �$ ,o.trY�'xauxY.vas.r .�i�v`.z:.-+Y-w.y,,. � l Approximate number of feet from well to O a nearest source of possible contamination: The undersigned is aware that upon completion of the well, a"Weil 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 jObmmission on the form provided by the agency. This permit is not valid until all information is filled in and it has been counter-signed by the Dire rof Health or his agent. APPLI NT aatam APPLICANTS ADDRESS . ` REGISTRATION NO. y� a 5`_iave s T30 lox 4`f6 �v'i s t ling—1 on 42 BY(Town Health Pfficer or gent) DATE k APRROV�D REJECTED '.l�s 1 �s REMARKS; ` i i DIRECTOR OF HE-ALTH