HomeMy WebLinkAboutDrain Layers Permit 220 Beelzebub Road TOWN OF AAA WI N DSOR
DEPARTMENT OF POLLUTION CONTROL gip No .
South Windsor, Connecticut
List No.:
DRAIN LAYER'S PERMIT
O 609
19 — --
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated.;below at � h s � � � -• °_- , a::::� � 1-L,y-�� on the
I► side, between 'i $��6'�#
'at premises owned by "i-:xs#'3li
whose address isru -
and to X Lay House Drain, Repair House Drain, Lay-Main, Other
for Mz Lvg t#r:a. 4 occupancy or use,
with Q Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( ), INDUSTRIAL WASTES .( ), OR
Connection will be made with a =r
Permit to be issued to
the holder of Drain Layer's License No. jqm,'dXsjr i Permit will expire on 19
h�The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on tmi1* nd 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 {,fir Licensed Drain Layer
1Y +. :YF3� Issued by Y, .
Tax Collector. *y ti ;
Permit Fee:. Paid $
INSPECTION: Check Number:
INITIAL
�+°".., �� �� �"�1�,, (Sig)
FINAL r �/1� 1 r (Sig)
,✓�' RTC/ 7 ±�
APPROVED ,--' �- °' g p (Date)
(Sig)
INSPECTOR
N
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION G
OWNER -
TYPE OF WORK
DATE 7 PERMIT .1-Clq PIPE ZVC,
INST R Z-,*I,-,-7 o,-
INSPECTORJ. DRAWN BY "- Lf;