HomeMy WebLinkAboutDrain Layers Permit 0169 Avery Street TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
1 South Winasor, Connecticut
DRAIN LAYER'S PERMIT N° 497
to amw&ft ' 19--- -
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at E on the
side, between jad
at premises owned by VW & ftuftw �rit t.9at /—
whose address is
and to It Lay House Drain, Repair House Drain, Lay Main, Other
for ' occupancy or use,
with fto Family Units, with acres.
Type of Sewage to be connected under this permit:
(SANITARY SEWAGE INDUSTRIAL WASTES, OR
Connection will be made with ilk 0Iat i € t 1544
Permit to be issued to Aft& I * WImatuaft
the holder of--Drain Layer's License No. Permit will expire o4 a_dmaw 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
t _
Signed e-. •' t t.t .., r
Connection Charge /Paid jaw Licensed Drain Layer-
10 o 143 (Sig) Issued by 4, J
Tax Collector
Permit Fee: Paid $ `
INSPECTION:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR r`"
N
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION la
OWNER
TYPE OF WORK
DATE o PERMIT PIPE
INSTALLER UW
INSPECTOR DRAWN BY 00 J'