HomeMy WebLinkAboutDrain Layers Permit 16 Autumn Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL gip No.:
South Windsor, Connecticut
List.No..
DRAIN LAYER'S PERMIT N? 1499
19 �
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at 'C�8 A weW nN sic Lo 7 / on the
side, between
at premises owned by /u kfk
whose address is
and to _Lay House Drain, Repair House Drain, Lay Main, Other
for j&,S(.V A)7-/44= occupancy or use,
with 6 AIC Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE (X, INDUSTRIAL WASTES ( ), OR ( )
Connection will be made with �ql���'i
Permit to be issued to 99AI sS? ^Wj)
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 icen Drain Lay&
Tax Collector Issued by
Permit Fee: Paid $
INSPECTION: Check Number: %16
INITIAL (Sig)
FINAL r (Sig)
APPROVED (Date)
(Sig)
INSP CTOR
2,
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION Lo-r /&
OWNER a4e-
- TYPE OF WORK NoU5E
�rar.r DATE PERMIT PIPE
INSTALLER
INSPECTOR DRAWN BY