HomeMy WebLinkAboutDrain Layers Permit 105 Andreis Trail TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT O 3243
19 .
Pursuant to written app scat r, p missionni hereby gran a to the Licensed Drain Layer named herein to perform
the work indicated below at d on the
side, between
at premises owned by
whose address is
and to Lay House Drain, Repair House Drain, Lay Main, Other
for occupancy or use,
with Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( ), INDUSTRIAL WASTES .( ), OR ( )
< Connection will be made with
a
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
(/ Z_W Signed
hnnect,ion Charge Paid 0 0. O Licensed Drain Layer
� , � Issued by
or15Permit Fee:. Paid $ _�_,
INSPECTION: Check Num�tr
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR