HomeMy WebLinkAboutDrain Layers Permit 072 Bayberry Trail TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT N?
, 19
Pursuant to written appli atio , permission is hereb granted to the Lic,nsed Drain Layer named here' to"per form
the k indi red below at er b • on the
side, betty en
at premises owned by
whose address is
and to -XLay 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 ( , INDUSTRI WA TE� ), OR ( )
Connection will be made with
Permit to be issued to
the holder of Drain Layer's License No. -3 Permit will expire on 19
The undersigned Drain Layer hereby agree to all the terms and conditions set forth on the permit an the reverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS
Signe
Connection Charge Paid icens rain Layer
- Issued by
Tax Collector
Permit Fee:. Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED —7 7 (Date)
(Sig)
INSP TOR
N
oG
s�
Xv.�r
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION at - l j ,i
OWNER ,
"//c TYPE OF WORK a,'
DATES �o-7 PERMIT PIPE
INSTALLER
�f� l INSPECTOR DRAWN BY
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TOWN OF SOUTH WINDSOR
TOWN HALL
SOUTH WINDSOR, CONN. 06074
DEPARTMENT POLLUTION CONTROL
Date . . ,` s . . . . . . . . .
The Sanitary Sewer . . .X. Septic System
4� . . . . . . . . . . . . .
at . . .
or lot J�3 bee '. stalled and completed
in accordance with the Town of South Windsor ordinances
and regulations.
Accepted Approved
Date
ell
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