HomeMy WebLinkAboutDrain Layers Permit 270 Beelzebub Road TOWN OF SOUTH WI N DSOR
$. DEPARTMENT OF POLLUTION CONTROL Bhp No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMITO 35Q2
19 o-'v
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain yer na d herein to perform
the work indicated below at f� o� �0 on the ,
side, between
at premises owned by'
whose.address is j
p and to Lay House Drain, Repair House Drain, Lay-Main, Other
l for occupancy or use,
k
r 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 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.
x :
for street excavation.
SPECIAL CONDITIONS
Signed
Connection Charge Paid Licensed Drain Layer
Issued by
Tax Collector _
f Permit Fee: Paid $
36 a`L .
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR