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HomeMy WebLinkAboutDemolition and Remodeling 1973 4 TOWN OF MONTVILLE Department of Public Works Application for Building Permit Application & Permit No. . . . 7 Estimated nate . . ./ � —�3 Cost ���, . . . . . . . . . Fee . . .$ .a.,9/. . . Owner . . . . . . . . . . . . . . . Address .4.� � . . . . . . . . . ,�4 . Contractor'; /` efe . . . . . . . . . . . . . . Address .' Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Address Location of Building . ‘ . . .� . . . • Additions & Alterations includi � Zone No n moving or demolition and sign erection) . _. . . . . . . . . . . . . . . . . . . . . . New Building — Type of Construction Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .. a. . . . . . . . . . . . . . . . . . . .. . . .. . .. .. . .. . . .. . . . Type of Heat .a=•G,E No. of Stories . . . . . .. .. . No. of Rooms . , , , , . " " " • • • • • • • • • • • . Fireplace . . . . . `. • . . • • • ' Breezeway No. of Baths . . . . . . . .. .(.:444--:c Proposed Use • �. . . . . . . . . . . . . Garage .,�Q�.c GZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I hereby certify that the proposed construction will conform to the applicable zoning regulations Town o f Montville and the Basic Building Code of the State of Connecticut. of the Signed . . . . . . . . . . . . . . . . . . . . . . a/. .� . . . . . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . Approved ... .. .. ... ,�'� � Date / Building Inspector . . . . . . . . . . . . . .. . . .. .. . . . ... .. . . . .. .. . . . ... .. . . Form No. BIMO 70-100-1 WELL COMPLETION REPORT STATE OF CONNECTICUT WDB-5 1249 REV. 9-71 WELL DRILLING BOARD ° Do NOT fill in State Office Building STATE WELL NO. HARTFORD,CONNECTICUT 06115 OTHER NO. OWNER NAME (=;u:;3Q11 �.u1,�,r) ADDRESS LOCATION (No.& Street) ..w.',.1‘.; Town v<A< .,_...4 ..;.;,...7.1,- r :. t OF WELL ) (Lott Number) PROPOSED BUSINESS ® DOMESTIC ❑ ESTABLISHMENT E.1 FARM ElTEST WELL USE OF WELL PUBLIC ❑ I-1 OTHER El INDUSTRIAL CONDITIONING (Specify) DRILLING n ROTARY ri COMPRESSED CABLE ❑ OTHER EQUIPMENT I I AIR PERCUSSION PERCUSSION LENGTH (feet) DIAMETER (Specify) CASING (inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED? DETAILS ;` 17 lbs.I Ell THREADED n WELDED nYES nN0 nYES nNO YIELD �7 I HOURS YIELD(G.P.M.) TEST I 1 BAILED n PUMPED COMPRESSED AIR 4 8 WATER MEASURE FROM LAND SURFACE–STATIC (Specify feet) DURING YIELD TEST(feet) LEVEL G,� l t Depth of Completed Well 1 • :+4U f t• in feet below Land surface: 245 f t. MAKE LENGTH OPEN TO AQUIFER(feet) SCREEN DETAILS SLOT SIZE I DIAMETER(inches) IF GRAVEL Diameter of well including GRAVEL SIZE(inches)IFROM(feet) ITO(feet) PACKED: ravel 9 pack(inches): DEPTH FROM LAND SURFACE FEET to FEET FORMATION DESCRIPTION Sketch exact location of well with distances,to at least two permanent landmarks. V it) ';.e ;.L'ut; i 10 150 .;r,ii =:::17.. .-d-t, 150 245 : icci i If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED PERMIT NO. I REGISTRATION NO. I DATG.4 REPORT inc.� WELL DRILLER(Signature) . /16/78 (17E84 4.1 I -'11.4/78 :i ee11 >ariliin:, i LOCAL DIRECTOR OF HEALTH