HomeMy WebLinkAboutDrain Layers Permit 0630 Avery Street TOWN OF SOUTH WINDSOR ,� A
DEPARTMENT OF POLLUTION CONTROL B/P No.:
r South Windsor, Connecticut
List No.: -5-" -5'80
DRAIN LAYER'S PERMIT
0 691
fi y ter. 21 00 tober , 19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at 630 Avery iitraet on the
4"t side, between et. %*ad Md =4 0ftV8
at premises owned by wAso 14jour + 0-an,,- }
whose address is
and to � Lay House Drain, Repair House Drain, Lay-Main, Other
for ` #% - occupancy or use,
with *s= Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE (1), INDUSTRIAL WASTES ( ), OR
Connection will be made with 8dX-tW% (6") AVO to 11&14 T*1 kjWMA I; o 1!+;1.4r at a
�P
Permit to be issued to A*0 5. Wi=iwaki
the holder of Drain Layer's License No. Permit will expire on 21 040ftb V 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 `� ' Licensed Drain Layer
C e . 618 Issued by
Tax Collector
Permit Fee:. Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL �yy /.a1f3 --- -" (Sig)
APPROVED (Date)
(Sig)
INSPE T R
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TOWN OF SOUTH WI'NDSOR
South Windsor, Conn. %
Date ... ...`/..�.............. ............. ...... ......4....,
N® 2
WELL DRILLER'S PERMIT
c l�
Of the fixxn o ......... .. .... ... .�......... a.....�... .. .
b/
�T ` ...............................................
\ .........:. .......�......... ..............
/.. . .......:`:.......................... ........... ...................................... (address) ..� ...........................
...................... .
hereby state that I (we) am (are a well driller duly and currently registered with the State of Connecticut Water Resources
Commission and do make application herewith for a Well Driller's Permit in accordance with the provisions of Public Act 187
of the 1963 Session of the Connecticut gislature, for 11tob/e�drilled on the property of:
Nameof Property Owner:.................... ...... ........ . - L ....... `. ................:....... ..... ..........................:.........
Address of Property Owner:.......................... .
,s _......... .... .... ... l
.............. ................................
Address of Premises on which well is located:............. ... 6,,,,, . • •.�f �............. ��s� v
The approximate location of the well will be as shown on the rev side of this perm'
The undersigned is aware that upon completion of this well the above data,together with a well log of information required
under, (e) and (d) of Public Act 187 of the 1963 Session must be sent : Water Resources Commission, 223 State Office
Building, Hartford, Connecticut on the form entitled"Well Completion port"which has
been suppli o re 'stered drillers.
. .... .. .. ...:'UVL........... ..... ...., ................
This permit is issued for a well lo
cated as shown to the above named well iller in accordanc with the Provisions of
Public Act 187 of the 1963 Session of the Connecticut Legislature this....................................day of................................................................ 196..........
.........................................................................................
WHITE—ISSUING AGENT Building Official or Town Clerk
GREEN—APPLICANT
PINK—LOCAL HEALTH OFFICER (Over)
CANARY—WATER RESOURCES COMMISSION (
Location of Well: Town,of::....::.... �✓1�..t..,'C .: `Z ....'�..':... .:.......
SKETCH SHOWING LOCATION OF PREMISES IN TOWN
(Show distance and direction from road intersection or other landmark) .
L�Z /
7
Diagram Showing Location of a.R on Premises:
Route Directions for Reaching Well Site from Nearest City or Village Center: