HomeMy WebLinkAbout2002-4-19 - 1001 Foster Street Extension - Well Drilling ApplicationPERMIT NUMBER
STATE OF CONNECTICUT 2 1 2 2 3 3
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE &PROFESSIONAL TRADES DIVISION
WELL DRILLING PERMIT
I 65 Capitol Avenue,Hartlord,Connecticut 06 1 06
CPR-B Rev.7195
LOCATION OF WELL (Town)(5W?!)‘(Lo!Number)DATES.WINDSOR 1001 FOSTER ST.EXT .4/1 9 /O 2
RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION
INDIVIDUAL Q BUILDER D OTHER (Specify)
OWNER'S ADDRESS
PAGANELLI CONST.P .O .BOX 652 ,S .WINDSOR
PROPOSEDUSE OFWELL
@KDIEKM D ausmEss D FARM [j ms,EsTAaLISHMENT WELL
SUPPLYPUBLIC E mousmAL AIRCONDITIONING (5mmomga ABANDO'
Est.No.olPeoplebeingserved.
ENT
SKETCH OF WELL LOCATION
Locate Well with respect to at Ieast two roads.showing distance from intersection and front of Iot
location of Iot to at least two roads Welt location on to and to hou if present)
Indicate North
mm $1 axr.
l I/L
)
nI’QSTerL 5T m 1i
Approximate numberoffeetfrom wellto ‘N/A ABANDONMENTnearestsourceofposslblecontamination.
The undersigned is aware that upon completion of the-well.a "Well Completion Report"containing construction details and information required under
Sedion 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 Commission on the fonn provided by the'agency.This permit is'not valid until all information is tilled in and it has been counter-signed by
the Diredor of Health or his agent.
A PLICA T{‘)APPLICANTS ADDRESSP.O.BOX 406 ,WILLINGTON,CT.REGISTRATION No.
4 2
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APPROVED REJECTED BY (Town Health OMcer or Agent)DATE
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