HomeMy WebLinkAboutDrain Layers Permit 160 Benedict Drive (2) r
TOWN OF • SOUTH W1 N DS,,OR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
t t South Windsor, Connecticut
^ " List No..
DRAIN LAYER'S PERMIT
y � 569
k t 19 `III,
f Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to"perform
the work indicated below at on the
side, between ,
at premises owned by it r
whose address is
and to _ Lay House Drain, Repair House Drain, Lay-Main, Other
for occupancy or use,
with` Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( ), INDUSTRIAL WASTES .( "), OR
Connection will be made with C;
Permit to be issued to
the holder of Drain Layer's License No. Permit will expire on 'da., °
The undersigned Drain Layer hereby agrees fo 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
Signed
Connection Charge Paid Licensed Drain Layer
r
* Issued by
Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL ; >x - (Sig)
FINAL (Sig)
y f.
APPROVED (Date)
r.. "
(Sig)
INSPECTOR