HomeMy WebLinkAbout2002-2-8 - 1009 Foster Street Extension - Well Drilling ApplicationCPR-8 Rev.7/95
LOCATION OF M£LL
S.WINDSOR 1009 FOSTER ST.EXT.
OWNER OF WELL
OWNER'S ADDRESS
STATE OF CONNECTICUT
DEPARTMENT OF CONSUMER PROTECTTON r
REAL ESTATE &PROFESSIONAL TRADES DIVISION
WELL DRILLING PERMIT
l 65 Capitol Avenue,Hartford,Connecticut 06 I 06
(Town)(Street){Lot Numbel)
Q INDIVIDUAL a BUILDER
PERMIT NUMBER
211140
OTHER (Specify)
DATE
2/8/02
RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION
—PROPOSEDUSE OFWELL
DOMESTIC BUSINESS [j TEST
EsTABLISHMENT WELL
PUBLIC INDUSTRIAL AIRCONDITIONING D (Speafy)
0THE_R
SUPPLY
'Est.Nov ofPeoplebeingserved.
4
SKETCH OF WELL LOCATION
'Locate well with respect to at least two roads,showing distance from inlersection and front of lot
location of lot to at least two roads Well location on to and to house (if present)
indicate North”Dam tut/L La "J3,
(JO ST 7\‘3T .a?
we ’bem 7 5 l
Approximate number of feet tram well to
nearest source of possible contamination:ABANDONMENT
The undersigned is aware that upon completion of the well,a “Well Completion Report"containing construction details and information required under
Section 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 form provided by the agency.This permit is not valid until all information is filled-in and it has been counter-signed by
the Diredor of Health or his agent.’'PPLIc rrs')APPLICANTS ADDRess
P .O .BOX 406 ,WILLIINGTON,CT .
REGISTRAnON No.
4 2 ‘
V ’\
'1 PROVED REJECTED
BY (Town Health Officer or Agent)
r?,/)72
DATE
3 ~1,3 *0 Z
REMARKS I V