HomeMy WebLinkAboutDrain Layers Permit 0189 Avery Street TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut
G- DRAIN LAYER'S PERMIT N? 491
02, . 119 7
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at Alta- on the
side, between
at premises owned by wifl ✓
whose address is
and to Lay House Drain, Repair House Drain, Lay Main, Other
for %ft 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 X J ?,j& Licensed Drain Layer
Per 14 JAU!, (Sig) Issued by a Est 011r.
Tax Collector
Permit Fee: Paid $.J
INSPECTION:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
N
i
r
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION .
OWNER
TYPE OF WORK 5 - -
DATE z%- r PERMIT PIPE
INSTALLER � 7r✓?
INSPECTOR zff DRAWN BY.