HomeMy WebLinkAboutDrain Layers Permit 0291 Avery Street TOWN OF SOUTH-W-fV lNDSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut «.
A
DRAIN LAYER' S PERMIT M 312
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Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at —� := > %�� on the
side, between -fi iE Y e L
at premises owned by /W,g2tv,%j
whose address is =8-'
and to X_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 ai-X IaC—'l ( ) 1016.4tia rig*
Permit to be issued to Vito COV44eu
the holder of Drain Layer's License No. Permit will expire on &1 3 1
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 Omit lay*,r to lmn, XNA CrUsh mad backfill pt wl
Signed
Connection Charge Paid $ v Licensed brain-Layer
(Sig) issued by
Tax Collector
Permit Fee: Paid $ ,
INSPECTION:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
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N
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION 2 v4 r
OWNER
TYPE OF WORK
DATE PERMIT PIME t/L
INSTALLER V I'-H-6 CoL/e,,/ s �`
INSPECTOR'M _ DRAWN BY t1