HomeMy WebLinkAbout1984-7-3 - 100 Long Hill Road - Well Drilling PermitCONSUMER PROTECTION
WELL DRILLING BOARDCPR-a nmmmaz STAYE OF CONNECTICUV
DEPARTMENT OF CONSUMER PROTECTION
wau‘DRILLING PERM”
I PERMIT NUMBER
87477.
16.5 CAPITOL AVE;HARTFORD,CONNECTICUT 06106
LocmtON OF WELL (I )
./.LubowxrJffOWNERWELL
INDIVIDUAL D BUILDER
WNER'S ADDRESS
OTIIER (Specily)
V)
'M
‘(Smet)(Lat Number)DA
2 /f&4
PROPOSED
USE OF
WELL
served.4—;
Locate well wilh respect Io o!lens!two toads,showing distance from intersection and Itonl of Ial
locaiion of Io!Io o1 Ieasl Mo loads
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Well locu'ion on Ioi and to house (if presen')
The undersigned is awore’Thai upon~completion of The well,o ”Well Complelion Repon"rconlaining consivuclion delails and informoiion required under ‘Seclion
25-131 of Ihe’1969 Supplemen'To the ‘Generol Statutes must be sent to the owner,the Board and the Water Resources Commission on the Iorm provided
-by.theu
APPLICANT'S ADDRESS
al O)ctr or Agni!)
REGISTRATION NO‘
This permit is not valid until oll information is fille and it has been counter-signed by the Director of Health or his agent.
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7s 34y
RETURN THIS COPY TO CONNECTECU.WELL DRILLING BOARD
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