HomeMy WebLinkAboutDrain Layers Permit 165 Berle Road TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List No.: _
DRAIN LAYER'S PERMIT ® 3359
19 do
Pursuant to written applic/a-tioorr, p ission is a granted to the Licensed Drain Layer named herein topeS/j
perforrm..
the work indicated below at
on the
side, betwe n
at premises owned by
whose address is
and to Lay House Drain, Repair House Drain, Lay Main, Other
for ,
occupancy or use,
with �'Z�Q Family Units,with
acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( ), INDUSTRI L WASTES .( ), OR ( )
Connection will be made with
Permit to be issued to 7 '
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
-�On
Signed
Connection Charge Paid ice Drain Layer
G Issued by
Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number: .
INITIAL
(Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR (Sig)