HomeMy WebLinkAbout1981-6-16 - 135 Clark Street - Well Drilling ApplicationCONSUMER PROTECTION
WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER
CPR-B REV. S-n DEPARTMENT OF CONSUMER PROTECTION 66289
WELL DRILLING PERMIT
20 GRAND STREET, HARTFORD, CONNECTICUT 06106
SOUTH
WINDSOR, CONN.
CLARK ST.
135
LotArloN Of 3VA`r-6UY LACHANCE
(LotNirmber)
DATE JUNE 16, 1981
OWNER OF WELL
® INDIVIDUAL
BUILDER
❑
OTHER (Specify)
OWNER'S ADDRESS
135 CLARK
ST., SOUTH WINDSOR
CONN.
06074
PROPOSED
❑X DOMESTIC
❑
BUSINESS
ESTABLISHMENT
❑ FARM
TEST
❑ WELL
Est. No. of
People being
USE OF
served.
WELL
PUBLIC
❑ SUPPLY. '
❑
INDUSTRIAL
AIR
❑ CONDMONING
OTHER
❑ (Specify)
SKETCH OF WELL LOCATION
Locale well with respect to at least two roads, showing distance from intersection and front of lot
Location of lot to of least two roads .
(a 1 co ei
Indicate North 1
�41 r
G t #-V. k Ste,
Approximate number of feel from well to
nearest source of possible contamination:
SC
z
Well location on lot and to house (if present)
L!r
L � �
Zo ��Ooi
f N..
The undersigned , is aware that- upon completion . of the well, a "Well Completion Report" containing construction details and information required - under Section
25131 of the 1969 Supplement to the General Statutes must be, sent to the owner, the Board and the Water Resources Commission on the form provided by -the
Board. This permit is.noi valid until all information is filled in and it has been counter-sl p
APPLI (S)g+r re APPLICANT'S ADDRESS 1L.+ rsr n.s.+..vv... I REGIST TION NO-
W BRITAIN, CONK. 06053 0
Av
PPROVED REJECTED
REMARKS
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a.a_1
RETURN THIS COPY TO CONNECfICUT WELL DRILLING BOARD