HomeMy WebLinkAboutDrain Layers Permit 0165 Avery Street (3) TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No:: �
South Windsor, Connecticut
List.No.: _
DRAIN LAYER'S PERMIT
p 65
• 233:1W4 , 19
Pursuant to written applicatior,permission is hereby granted to the Licensed Drain Layer named herein to perform
the.work indicated below at '
on the
side, between
Nib $3,'�i1
at premises owned by
whose adgifess is $
me
and to X Lay House Drain, Repair House Drain, Lay-Main, Other
for '
occupancy or use,
with 0" Family Units, with acres.
Type of Sewage to„be connected under this permit:
SANITARY SEWAGE ( , INDUSTRIAL WASTES .( ), OR '(
Connection will be made with six $ Pl"tie NO
Permit to be issued t-0, Ae
Xemu
the holder of Drain Layer's License No.W%� Permit will expire on 103/2"4 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
V*Mk Jr S"t►ir
- Tax Collector Issued by
Permit Fee: Paid $
INSPECTION:• Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR