HomeMy WebLinkAboutDrain Layers Permit 024 Ash Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL Bhp No.: ----11�
South Windsor, Connecticut
List.No.. _
DRAIN L.AYER'S PERMITp 678
' ueww , 19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named he to perform
the work indicated below at—A i Z 5/ .ems .mod i on the
side, between finis"
at premises"owned by_ &
whose address is
and to XLay House Drain, Repair House Drain, Lay-Main, Other
for lea -x= occupancy or use,
with tom, Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE (19), INDUSTRIAL WASTES".( ), OR
Connection will be made with h too) #�C A to A at a
Permit to'be issued to J6 IMM
the holder of Drain Layer's License No. Permit will expire on 20401110M ig
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 Licensed Drain Layer
I e*i * Issued by IWJ VIR 07W A s ITS-$
Tax Collector
Permit Fee:. Paid ,._ '
INSPECTION: Check Number:
INITIAL _;r• � (Sig)
FINAL $:": _=a...W. ...;. (Sig)
APPROVED ` (Date)
(Sig)
INSPECTOR"