HomeMy WebLinkAbout1964-6-3 - 14 Grace Road - Well Drilling ApplicationNo 13
Date .. . ._.... ..��"C...c...
WELL DRILLER'S PERMIT
r........................._% ......, of the firm af....-,... ..:::......,..... ,......._�..,.......:._....,...._.,�.......-..._. ...........
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hereby state that I (we) am (are) a well thriller duly and currently registered with the State of Connecticut Water Resources
Comrission and do make application herewith for a Well Driller's Permit in accordance with the provisions of Public Act 187
of the 1-968 Session of the Connectic Legislature, r a well to be drilled on the property of:
........................ ......--...........................:.-:--....................-..- ......—
l�itune of Property Owner:......----..--�r��............. ....
Address of Property Owner:...,. ......,r ......... ......-ram:-.-.. .. ....
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Address of Premises on which well is located:.-....- :__...
The approximate location of the well will be as shown on the reverse side of this permit.
The undersigned is aware that upon completion of this well the above data, together with a well log of information required
under (c) and (d) of Public Act 187 of the 1963 Session must be sent to: Water Resources Commission, 223 State Office
Building, Hartford, Connecticut on the form entitled "Well Completion port" which has b n supplied to registered drillers.
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This permit is issued for a well located as shown to the above coed well dril 4in ccordee with the Provisions of
Public Act 187 of the 1963 Session of the Connecticut Legi% re is......- d 196..WHITE — ISSUING AGENT .» .GREEN — APPLICANT `�1uiklincial o own Clerk
PINK— LOCAL HEALTH OFFICER Y 1�
CANARY — WATER RESOURCES COMMISSION (Over) 't
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TOWN OF SOUTH WINDSOR
South Windsor, Conn.
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