HomeMy WebLinkAbout2002-2-8 - 1042 Foster Street Extension - Well Drilling ApplicationCPR-8 Rev.7/95
STATE OF CONNECTICUT
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE &PROFESSIONAL TRADES DIVISION
WELL DRILLING PERMIT
I 65 Capitol Avenue,Hartford,Connecticut 06 I 06
PERMIT NUMBER
211139
RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION
LOCATION OF WELL (Town)(Street)(Lot Number)
S.WINDSOR 1042 FOSTER ST.EXT.
DATE
2 /8 /0 2
OWNER OF WELL INDIVIDUAL a BUILDER OTHER (Specify)
OWNER'S ADDRESS
PAGANELLI CONST.P.0.BOX 652,SUFFIELD
PROPOSEDUSE OFWELL
g DOMEsrIc D BUSINEss D FARM B‘tES‘rESTABLISHMENTWELL
PUBLICSUPPLY B mousTRIAL AIRCONDITIONING B (Speafv)
OTHER
Est No.ofPeoplebeingsewed.
4
SKETCH OF WELL LOCATION
Locate well with respect to at Ieasl two toads,showing distance from intersection and front of Iot
location of lot to at least two roads Well location on to and Io house (if present)
Mm ll I LL {Lg
/
o ff 6 ll-
s a ‘€7<l ~
K\0
r
G\'
T BIL:umgy
m ‘il
I
u
Approximate number of feet from well to
nearest source of possible contamination:ABANDOMN
The undersigned is aware that‘upon completion of the well,a 'WeltCompletion Report”containing construction details and informationrequired 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 tilled in and it has been counter-signed by.
the Director of Health or his agent.
APPLICANT (Signature)APPLICANTS ADDRESS
P a 0 .BOX 406 ,WILLINGTON ,CT .
REGISTRATION N0.
4 2
I
PPROVED REJECTED BY (Town Health Olii‘cer or Agent)
9/0.
DATE
j—/3 ~0 a
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