HomeMy WebLinkAboutDrain Layers Permit 70 Autumn Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List.No.:
DRAIN LAYER"S PERMIT NO 1497
S Fr eg , 19 leg
Pursuant to written applicatior, permission i hereby granted
�tothe Licensed Drain Layer named herein to perform
the work indicated below at 76 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
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 �'L. icens Drain Layer
Issued by
Tax Collector
Permit Fee:. Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED q — 'do" (Date)
.. , � (Sig)
INS CTOR
t
SZ �
1
22
Al
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION LoY
OWNER 1A fM
TYPE OF WORK lea v\ec-k &n,,
DATE -12 PERMIT it PIPE " PV C
INSTALLER
INSPECTOR DRAWN BY