HomeMy WebLinkAboutDrain Layers Permit 0338 Avery Street TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut J 3
List.No.: _
DRAIN LAYER'S PERMIT Np 1398
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to"perform
the work indicated below at 3 , A yap-\t srR cE 1 on the
side, between
at premises owned by �
whose address is_ �QV1R @ ja G (�\cOV�.•
and to V Lay House Drain, Repair House Drain, Lay-Main, Other
for RESIM a NT I AL. occupancy or use,
with ( NEl Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE (X INDUSTRIAL rWASTES .( ), OR..( )
Connection will be made with D
Permit to be issued to M&X\Al NEA Qs'T1-�tECLS
the holder of Drain Layer's License No. 3 2 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 Licens Drain yer
wIssued by
Tax Collector
0
Permit Fee:. Paid $ _
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR (Sig)
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t
N
t i
f
VC, /4-
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER
TYPE OF WORK
DATE PERMIT PIPE
INSTALLER
INSPECTOR DRAWN BY