HomeMy WebLinkAbout2002-2-25 - 1051 Foster Street Extension - Well Drilling ApplicationCPR—8 Rev‘7/95
.’-‘A PERMIT NUMBER
RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION
2 1 1 7 1 4STATEOFCONNECTICUT
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE 8!PROFESSIONAL TRADES DIVISION
WELL DRILLING PERMIT
1 65 Capitol Avenue,Hartford.Connecticut 06 1 06
LOCATION oF WELL (Town)(Street)(Lot Number)
S .WI NDSOR 105 1 FOSTER ST .EXT .
DATE
2 /2 5 /O 2
OWNER OF WELL INDIVIDUAL D BUILDER D OTHER (Specify)
OWNER'S ADDRESS
PAGANELLI CONST .—P.O.BOX 652,S.WINDSOR
PROPOSEDUSE OFWELL
DOMESTIC D BUSINESS g D T551
ESTABLISHMENT WELL
PUBLICSUPPLY a INDUSTRIAL AIRCONDITIONING D (Speafy)
OTHER
Est.No.of.People beingsewed.
4
SKETCH OF WELL LOCATION
Locate well with respect to at least two roads.showing distance from intersection and front of lot
Iocation uf Iot to at least two Toads Well location on to and to house (if present).
Indicate North
‘over;ST;E$t,3M~A
MI LLew
\
Hovb‘:
IEhHm.‘(zg
7 Approximate
nearest source
numberof
of possible
feet
contamination:
from well to A BANDONMENT
The undersigned is aware that upon completion of the well.a ”Well Completion Report”containing construction details and information required under
.Section 25-131 of the 1969 Supplement to the General Statutes must be sent to the owner,the Department of Consumer-Protection and the Water
Resources Commission on the form provided by the agency.This permit is not valid until ail infonnation is filled in and it has been counter-signed by
the Diredor of Health or his agent.
PLICANT(S‘APPLICANTS ADDRES$
P .O .BOX 406 ,WILLINGTON,CT .
REGISTRA‘HON N04
4 2
r
PPROVED REJECTED
BY (Town Health Officer or Agent)DATE3 ”/3Po Z
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