HomeMy WebLinkAboutDrain Layers Permit 0678 Avery Street TOWN .OF S-OUTW,.WfNDSOR
DEPARTMENT OF POLLUTION CONTROL gip No.:
South Windsor, Connecticut
List No.:
DRAIN LAYER'S PERMIT N? 553
21974
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at Awny at, �Lerr 1o ) on the
side, between PSAW 9114b ZhWt J= V4*
Is
at premises owned by f"e 40hft V*k i -4�
whose address is
and to XX
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 QIX), INDUSTRIAL WASTES ( ), OR
Connection will be made with "X(clach p1ue
Permit to be issued to__ tt
the holder of Drain Layer's License No. " Permit will expire on *%V 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 BMW
Signed
Connection Charge Paid Licensed Drain Layer
PWs► Issued by As 3
Tax Collector
Permit Fee: Paid $ _�T__
INSPECTION: Check Number:
INITIAL 0 L-x;,_• 44' ' (Sig)
FINAL j (Sig)
APPROVED (Date)
.4 .`' �-' �-�. .; ,• � (Sig)
- • �}g 7NSP lZ '
N ) t )
A�
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Y
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION e 2 -qY. s'
OWNER J90P, c% .Al G�✓G�rPr
TYPE OF WORK �ATAL-
DATE PERMIT 1� PIPE Y�
INSTALM V rglVaCI-7'�
INSPECTOR DRAWN BY 1'