HomeMy WebLinkAboutDrain Layers Permit 60 Benedict Drive TOWN _ OF SOUTH VIII N:DSOR
DEPARTMENT OF POLLUTIQN CONTROL' s
B/P No.
So�uxk.INmdsor, Conhec06uf 6e7Z
z List No:. _
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DRAIN 'LA.YER'S PERMIT 1000
;
Pursuant to written npplicatior, permission is hereby granted to the Licensed Drain Layer named herein to perfoirm
the.work indicated.below at 1 ' .60 Bjo
OdA At. Avon on the
t
raw . side, between,,Pi�w_ ,t 6: and_PA131� ��itie
at premises owned by T"'•e �IZL`
whose address is g"s
and to _XLay House Drain, Repair House Drain, Lay Main, Other
for. "All dhoo4i43 . occUpAncy
with Family Units, with acres,
Type of.SewAge to be connected'under this permit:
SANITARY:SEWAGE ( X% 1 DUSTRIAL WASTES .( ), `OR ( )
Connectiop will be made with tic ids—=
Permit to be issued to AE7aIT$ i1Vak .
the holder of Drain Layer's License No Permit will expire on,$1 �' 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.
for street excavation.
SPECIAL CONDITIONS
I
Signed
Connection Charge Paid-"11--177"?.5 Lr sed Drain aye? "
Issued by M01YiA ;LWa3F4X Jr.-
Tag Collector
Permit Fee:. Paid
INSPECTION: Check Number: 3P77
INITIAL f��1/f + IdJ (Sig)
FINAL 1R'. ':. (Sig)
APPROVED ► (Date)
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