HomeMy WebLinkAboutDrain Layers Permit 12 Birch Road TOWN OF SOUTH WINDSOR
DEPARTMENT OF PJOLLUT10N„CONTROL
South Windsor,;Connecticut
j UA a 9
DRAIN LAYER'S PERMITO 189
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at on the
side, between_soft ft"a
at premises owned by i i
whose address is ilk
and to Lay House Drain, Repair House Drain, Lay Main; Other
for IIIO
occupancy or use,
with Family Units, with acres.
Type of Sewage to be connected under this permit:
cAXTrcrenX S"Arjj, INDUSTRIAL WASTES, OR
Connection will be made with
Permit to be issued to r
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 wwv� mp"r ova me ukolI '
Signed t..
Connection Charge PAN, F Licensed Drain Layer
(Sig) Issued by
Tax Collector
- P mt F Paid $
INSPECTION:
INITIAL- (Sig)
FINAL (Sig)
APPROVED MWO (Date)
(Sig)
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NOTES SOUTH WINDSOR POLLUTION CONTROL
Brawixg xot to scale. LOCATION 12 Birek Road
OWNER Wilfred Fortix
TYPE OF WORK Sewer Coxxeetiox
DATE o5-11-73 PERMIT 18q PIPE6"-Plant,
INSTALLER Lammox (W9-206188)
INSPECTOR ME DRAWN BY ME