HomeMy WebLinkAboutDrain Layers Permit 160 Benedict Drive r°TOWN OF-SOUTH WI N DSOR
s DEPARTMENT OF POLLUTION CONTROL gip No.: _
s
1 South Windsor, Connecticut
List No.: ' 3
=3 DRAIN LAYERS PERMIT
s ' N? 569
F
1 l =r 4 19 �`
I Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below atl= '"#� � - , ( /? on the
f- side, between_
at premises owned by P—,7P-2-4,,_`21 ;
whose address is s ry
and to _Lay House Drain, Repair House Drain, Lay-Main, Other
for occupancy or use,
with r,. Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE (tv,j, INDUSTRIAL WASTES .( ), OR ( )
fr
Connection will be made with _j
Permit to be issued to
the holder of Drain Layer's License No. 1 Y3 Permit will expire on 19 `
4-71
The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on the permif and the reverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS 741A,41 F^'
Signed
Connection Charge Paid ,11 Licensed Drain Layer
Issued by
— Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number: -
INITIAL (Sig)
�4.
FINAL �`• ; rs r +` '— (Sig)
APPROVED (Date)
w INSPKTOR (Sig)
N
P
LL i 1
I
i
1
1
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION elyg icT ial
OWNER
TYPE OF WORK
DATE PERMIT G PIPE c-
INSTA LE
INSPECTOR , DRAWN BY fJ