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HomeMy WebLinkAboutDrain Layers Permit 367 Benedict Drive TOWN OF SOUTH WI N DSOR DEPARTMENT OF POLLUTION CONTROL B/P No.: South Windsor, Connecticut List No.: DRAIN LAYER'S PERMIT N? 1932 , 19-7,9 Pursuant to written applliJicatior, permission is hereb granted to the Licensed Drain Layer named herein to perform the work indicated below at 36 C/I on the side, between at premises owned by `y—AIIIIJ�-kq 4fCy lc-d A4^Ccftj S whose address is , and to Lay House Drain, Repair House Drain, Lay-Main, Other for �� v ../ occupancy or use, with C7)" Family Units, with acres. Type of Sewage to be connected under this permit: /JY SANITARY SEWAGE ( , 'INDUSTRIAL WASTES ( ), OR ( ) Connection will be made with �0 l ,� 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. for street excavation. SPECIAL CONDITIONS v ,y © � ` Signed Connection Charge Paid 11479 Licensed Drain Layer Issued by Tax Collector Permit Fee: Paid $ 1��_// L 7X6 INSPECTION: Check Number: INITIAL (Sig) FINAL (Sig) APPROVED I z. (Date) (Sig) INSPECTOR a I I ' i I � � vP NOTES SOUTH WINDSOR POLLUTION CONTROL D LOCATION TD f v t/ C^ OWNER Rvlort TYPE OF W RK 41 g 1c,4 eee,.. DATE z PERMIT Z PIPE (o v INSTALLER ac cc� c r INSPECTOR D WN BY L