HomeMy WebLinkAboutDrain Layers Permit 0815 Avery Street TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut S List No.:
DRAIN LAYER'S PERMIT NO 1715
19 ']9
Pursuant to written applicatior, permission is hereby granted�f o the Licensed Drain Layer named herein to perform
the work indicated below at on the
side, between
at premises owned by
whose address is
and to Lay House Drain, Repair House Drain, Lay Main, Other
for //j?,Q �occupancy or use,
with :0Q Family Units, with acres.
Type of Sewage to be connected under this permit: =
SANITARY SEWAGE ( , INDUSTRIAL WASTES .( ), OR ( )
Connection will be made with / _ C,�
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.
SPECIAL CONDITIONS
Signed .r hLn L / / )
Connection Charge Paid HIZY LicensvA Drain dyer
Arl ( ` 1Z. Issued by
Tax Collector
Permit Fee:. Paid $ —f
INSPECTION: Check Number: ��
INITIAL (Sig)
FINAL �- (Sig)
APPRO Z S2 (Date)
(Sig)
INSPECTOR
N - -
1
I
E �
I f Mi
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION ;
OWNER
TYPE OF WO ��
DATE 5 PERMIT 1 PIPE
INSTALLER
INSPECTOR < DRAWN BY