HomeMy WebLinkAboutDrain Layers Permit 19 Andmar Lane TOWN OF SOUTH WI N DSOR
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DEPARTMENT OF POLLUTION CONTROL BAP No.:
South Windsor, Connecticut
List.No.:
DRAIN LAYER'S PERMIT NO 1508
Sx PT . 2-1 , 19_jig
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at 0.\n \Mtk t\, LDT `L" on the
side, between
at premises owned by a
whose address is
and to _ Lay House Drain, Repair House Drain, Lay Main, Other ,
for AE S 1 D E/U t 1141.. occupancy or use,
with Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE (�Q, INDUSTRIAL WASTES ( ), OR ( )
Connection will be made with
Permit to be issued to
the holder of Drain Layer's License No. Permit will expire on 19
The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on the permit and the reverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS
Signed
Connection Charge Paid j-Z52- icensed Drain Layer
A—M-719 Issued by
Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number: , 1110 &L
INITIAL (Sig)
FINAL (Sig' SCANNED
APPROVED Z " ? (Date)
(Sig)
INSPECTOR
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NOTES SOUTH WINDSOR POLLUTION CONTROL
iq1 e� LOCATION
OWNER 0
TYPE OF WORK Co yi r, �
DATE Q-1Z--1'7 PERMIT 15K PIPE " PV
INSTALLER
INSPECTOR DRAWN BY A •c''
SCANNED