HomeMy WebLinkAboutDrain Layers Permit 0120 Avery Street (2) TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL gip No.:
� South Windsor, Connecticut �� �
List No.:
DRAIN LAYER' S PERMIT NO 1941
, 19 7
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at on the
side, between
at premises owned by 99 .
whose address is
and to Lay House Drain, Repair House Drain, Lay-Main, Other
for occupancy or use,
with ej�tj Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( INDUSTRIALWASTES .( ), OR ( )
Connection will be made with _ /14 l /mac
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
say-7y _
?j S� i/ Signed
Connection Charge Paid `7a� Licensed ain Layer
Issued by
Tax Collector ml 00
Permit Fee: Paid $
INSPECTION: Check Number: , I3
INITIAL (Sig) /010 jquerY
FINAL (Sig)
APPROVED Z' 3 (Date)
(Sig) 0
INSPECTOR
,I
IJ t
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION F ? `'
OWNER _'
TYPE OF WORK SAW 5e
DATE PERMIT 1 PIPE
INSTALWRy' ; ,, .` ".,.•_
INSPECTOR DRAWN BY