HomeMy WebLinkAboutDrain Layers Permit 0425 Avery Street TOWN OF SOUTH WI N DSOR
• DEPARTMENT OF POLLUTION CONTROL
B/P No.:
rs South Windsor, Connecticut
List No.: _ IZ
DRAIN LAYER'S PERMIT NO 1289
2.. 19
Pursuant to written applicatior, permissi s hereby $rantpZo the Licensed Drain=Layer named herein to perform
the work ' dicated, , low at U 1 on the
I've 1 -
side, between
at premises owned by-
whose address is
and to XLay 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 ? j, INDUSTRI L W�A"S 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 permit and the reverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
SPA CONDITIO V �l u /V / tlo
Signed
Connection Charge PaidLicensed Drain Layer
Issued by
Tax Collector
/V U is/ / Permit Fee: Paid $
�XJ
INSPECTION: Check Number: T.
INITIAL (Sig)
FINAL (Sig)
APPROVED '_Z" (Date)
/ /y
k d c
�ze l (Sig)
INSPECTS
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NOTES SOUTH WINDSOR POLLUTION CQNrROL
LOCATION
OWNER ov ir7
TYPE OF WORK
DATE - E I PIPE
INSTALLER
INSPECTOR DRAWN BY