HomeMy WebLinkAboutDrain Layers Permit 0175 Avery Street TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL BAP No.:
South Windsor, Connecticut
List.No.: _
DRAIN LAYER'S PERMIT NOO 1614
19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to-perform
the work indicated below at �.r� S/
_ on the
1:�
side, between
at premises owned by � '�� 13 /2-�0���
whose address is—`
and to 7✓_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 �Ci
Permit to be issued to_,i� I','� ✓� J`r �� '� fib//GLr'A/�Z d�/_G ��
the holder of Drain Layer's License No. Permit will expire on
The undersigned Drain Layer hereby, agrees to all the terms and conditions sec 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
Zr Signed
Connection Charge Paid 1333 a-ZiL�icense`dDrain Layer
Tax Collector Issued by _
Permit Fee:. Paid $
INSPECTION: Check Number:
INITIAL //�� (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR (Sig)
45
UNDEK (3oT/o^�, 3 W�CLE A N1 C> Ur
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A N
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION 175 kvLRy 3T-PEET
OWNER G 0 R G e �upzC9E� E
TYPE OF WORK 5 A W, S -a W i1 i C.rt°\L—
DATE S It /-;LLERMIT77.i PIPE 6.77
INSTALLER r f
INSPECTOR 'DovigZDRAWN BY Q L sk