HomeMy WebLinkAboutDrain Layers Permit 0292 Avery Street TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List.No..
DRAIN LAYEVS PERMIT N? 1216
4- 19 , 19��
Pursuant to written application, permission is hereby g d to the Licensed Drain Layer named herein to"perform
the work indicatV
d below at Z97� Ue� on the
�• t
�0 side, between
at premises"owned by
whose address is
and to Lay House Drain, Repair House Drain, Lay-Main, _6Other
for occupancy or use,
with / Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE (><, INDUS L WAS S . ), 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 per and the reverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
PEC�L CrITK9NS
Signed
Connection Charge Paid icensed Drain Layer
Issued by
Tax Collector
Permit Fee:. Paid $ 11)
_ �S• v�
INSPECTION: Check Number: ��
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
N
� I
NOTES SOUTH WINDSOR POLLUTION CO ROL
O�d 111Q� LOCATION
OWNER If ,.
TYPE OF WORK
r / DATE - - PERMI / PIPE H
?'c INSTALLER 60, M'11,f'
INSPECTOR j2ZZ DRAWN BY
t
4
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si
a s�
Ail
Aw
LILL-
y�
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t �K�
p� � Fes+ � - - $ ,•{ 6-.+ / � � -.
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TOWN OF SOUTH WINDSOR
TOWN HALL
SOUTH WINDSOR, CONN. 06074
DEPARTMENT POLLUTION CONTROL
Date . . `T. . . . . . . . . . . . . . . .
The Sanitary Sewer . . . Septic System ... . . . . . . .
4/. . . . . . . . . . . . . . . . .
at
or lot #. . s been installed and completed
in accordance with the Town of South Windsor ordinances
and regulations.
Accepted and Approved
sy
�� t� Date
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