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TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor,Connecticut
List No.: _
DRAIN LAYER'S PERMIT
O 2544
19 C r,
Pursuant to written applicatior, permi sion is hereby gr nted to the Licens d Drain Layer named herein to perform
the work indicated below at Q a�
on the
side, bet een
at premises owned by �4
•` whose address is
and to Lay House Drain, Repair House Drain, Lay-Main, Other
for
occupancy or use,
with Family Units, with acres.
f Type of Sewage to be connected under this permit:
c
SANITARY SEWAGE;( ), INDUSTRIAL WASTES ,( ), 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.
SPECIAL CONDITIONS
Signed
nectio jnn Charge Paid J Licensed Drain Layer
Issued by
x Collector
U Permit Fee:. Paid $ ( ��
INSPECTION: Check Number: 3�
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR (Sig)