HomeMy WebLinkAbout1996-3-15 - 113 Beelzebub Road - Abandoned Well Drilling PermitCPR-9jRev.,7S5 PERMIT NUMBER
t_ a STATE OF CONNECTICUT 174706
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE 8i PROFESSIONAL TRADES DIVISION
WELL DRILLING PERMIT
165 Capita venue, Hartford, Co ectieut 06106
SouTH W � MAso 3 Irr1_,Z 3v
LOCATION OF WELL (Town) (S&-O (LdNumber) DATE
R is 11 � W A V.,I t--1 1� �'j 3 �� 6
OWNER OF WELL
INDIVIDUAL BUILDER OTHER (Specify)_
OWNER'S ADDRESS
r-51. rtu. vi
PROPOSED DOMESTIC BUSINESS FARM El TEST People being
USE OF ESTABLISHMENT WELL served.
WELLEPUBLIC AIR j�
SUPPLY INDUSTRIAL CONDITIONING E [specify) + #/& H7f,
SKETCH OF WELL LOCATION
Locate well with respect to at least two roads, showing distance from intersection and front of tot
location of lot to at least two roads. Well location on to and to house (if present)
N
Indic to North
� l +
r
`BLF�L Zt-BL-t3 ,C�l -
Approximate number of feet from well to
nearest source of possible contamination:
The undersigned is aware [hat u on completion of the wel$, a 'Well Completion Report' containing construction details and information required under
Section 25-131 of the 1969 Su ement to the General Statutes must be sent to the owner, the Department of Consumer Protection and the Water
Resources Commission on the r ed by the agency. This permit is not valid until all information is filled in and it has been counter -signed by
the Director of Health or his aae _ —
CONIiECTICUT WLEY ARTWAN WELL CO. INC.
or
PROVED ❑ REJECTED
NARKS
Wg -2-aIYO
3-/ -I! !; 11 6
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