HomeMy WebLinkAboutDrain Layers Permit 0145 Avery Street TOWN OF SOUTH WI N DSOR �4
DEPARTMENT OF POLLUTION CONTROL gip No.:
South Windsor, Connecticut I List.No.: _ �b
DRAIN LAYER"S PERMIT N? 1232
19 7
Pursuant to written applicatior, permiss a is hereby granf€d)go the Licensed Drain Layer named herein to perform
the work indicated below at : �; ". 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 (x), INDUS A L WASf S ( ), OR ( )
Connection will be made with t�
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 Licensed Drain Layer
Issued by
Tax Collector
Permit Fee:. Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
F17-
-
s�
1�6 AA
. VN
/S
NOTES SOUTH WINDSOR POLLUTIO ONTROL
LOCATIO
l'J° �✓�� k`,� OWNER
/ TYPE OF WORK
�� fh O -_Z;// DATE S-31-72 PERMIT 2.32 PIPE eelC
INSTALLER
UGt Cl� INSPECTOR CCe DRAWN BY