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HomeMy WebLinkAboutWell Abandond 460 Foster Street wn EtVED � . . PERMIT NUMBER CPR4 Rep 7195 r ., 4. 256426 STATE OF CONK CTICUT urn DEPAXtTMENT OF CONSUMED P20TECTION.. SOIJ IH U111ND$©fit EALESTA'I'E 8E PRIDESIONAL T�tADES M :IjEp tLIDAILLIN PER1VfYT i63'C�►pikolir4venue,Harttord,Connect cut f11410W ' DATE LOCATION OFVVEIL ? (Town) (Street). (LarNvinber)`:- ; OWNER OF WELL INDIVIDUAL' ml.DEg r OTFft3R(Sperfy t - OWNER'S ADDRESS Est No Of PRQPOSED DOMESTIC. El BUSINESS FARM TEST People being a .. . USE OF ESTABLISHMENT sen(ed x WELL :. -:- •. - � PUB4El 1G INDUSTRIAL. AIR; IaER SKETCH OF WEi:t LOCATION Locate well with[espect to at least two:roads,ahowin ,_distanoe'from interSectron8nd.frorft of!ot -`. locafign Af..loE tq at'teaSf.two:roads. = W$IklGcation_,g4 taandan house ;;'. : Indicate North • •„A' . 'saiF . •s sy. i' Ali L - • • a . ., ... .' _-yam .♦ .. - _ .. • v C�- - - S. Approximate nornber,of feet from well to nearest saurde of po siOle d&jf amihatl6n The undersigned is aware that upon completion of the well, a ell Completion Report rcontaimn .160hstruction'details and information required under'.,. Section 25-131 of the 1969 Supplement to the General Statutes must be sent to the oWnerj the Department.of Consumer Protection and the'Water ..., Resour s_ommission on the form provided bj the agen ermi `s t, id `tion is fi led in' n has been counter signed by _ the Di[ o of Health or.his a t AP N (Sign ure) IC MT' PRESS REGkSTt3ATIflN No r r 13Y:f Tawn"Health Qcer arAlgenE) l)A'fE AP! RtpVED REJE6TfD R� MA. 4. :. ... ,a".. . . :. .:.•'.. ; .:..:..'.': ,.: ::. ...:..,. ....:._DIRECTOR.OF HEALTH: _. .... ?s