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HomeMy WebLinkAboutDrain Layers Permit 090 Ayers Road y TOWN OF SOUTH WI N DSOR DEPARTMENT OF POLLUTION CONTROL B/P No.: _ South Windsor, Connecticut /1 List No.: _ DRAIN LAYER'S PERMIT NO34 ' 19 Pursuant to written applicatior, permission is.,hereby granted.to thg Licensed Drain Layer named herein to perform the work indicated low atZ C A/ on the Alamo side, between at premises owned by eL%� whose address is and to \4- 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 WAS f� s ), 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/ C H D Permit No. for street excavation. � � w� SPEC L CONDITIONS BCD all Signed �- Connection Charge Paid Licensed Drain Layer - Issued by Tax Collector Permit Fee: Paid $ _ A!6 d INSPECTION: Check Number: Z INITIAL (Sig) FINAL (Sig) APPROVED _7 Z (Date) (Sig) INSPECTOR OGv� �d _ - Flonlc A v qo N �2,6 66WIleclew Ylo/ 01-ao xi yal-, - NOTES 617C, , ty SOUTH WINDS-OR POLLUTION CONTROL 1211 Aell) u ea, ©ell LOCATI G �� OWNER (1/G TYPE OF W C�4 DATE - PERMIT PIPE CleVC INSTALLER INSPECTOR DRAWN BY