HomeMy WebLinkAbout462 Abbe Road PERMIT NUMBER
CPR-8 Rev.08)17
i
STATE OF CONNECTICUT
266524
. DEPARTMENT OF CONSUMER PROTECTION
' REAL ESTATE&PROFESSIONAL TRADES DIVISION
} WELL DRILLING PERMIT
450 Columbus BoulevardiSuite,901'. Hartford, Connecticut 06103
LOCATION OF WELL (Town) (Street) (Lot Number) DATE
South Windsor 462 Abbe"Rd 511 /1 8
OWNER OF WELL
aINDIVIDUAL BUILDER OTHER(Specify)
OWNER'S ADDRESS
Joe 13otti 462 Abbe qd South Windsor
Est.No.of
PROPOSED a DOMESTIC BUSINESS FARM TEST People being
USE OF ESTABLISHMENT WELL served.
.WEB
PUBLIC f 1NE3U3TItIAL ❑ AIR OTHEFh T�l1 ATE *jj- TT wT'�'
SUPPLY 1_I CONDITIONING i".t (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 to at least two roads Well location on to and to house(if present)
Indicate North5 G
15
T `4`
be,
Approximate number of feet from well to
k 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- 1 of the 1969 Supplement to the General Statutes must be sent to the owner, the-Department of Consumer Protection and the Water
r Resour C mission 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 Di of Health or his agent.
r AP T( re) APPLICANT'S ADDRESS REGISTRATION NO.
.: Joel Stavens PO F 416 ;>dillington 42
BY lr, Hea1th O#ice orAgent) fiE
APPROVED r' REJECTED
:` #tEfwilP�ItKti
.7
DIRECTOR OF HEALTH