HomeMy WebLinkAboutDrain Layers Permit 0678 Avery Street (2) TOWN OF SOUT#-fi tQSOR
DEPARTmtNT. OF- LUTiON eONTROL B/P No.:
South Windspr; Connecticut
List No.: _ f
DRAIN LAYER'S PERMIT
p 553
1974
Pursuant to written applicatior, permission is here-'by granted to the Licensed Drain Layer named herein to perform
the work indicated below at on the
side, between van au a*
at premises owned by
whose address is AIM
and to ' 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 ), 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 My 174
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
16
Issued by
Tax Collector
Permit Fee:. Paid $ __
INSPECTION: Check Number:
INITIAL (Sig)
FINAL ., (Sig)
APPROVED (Date)
(Sig)
INSPECTOR ,`