HomeMy WebLinkAboutDrain Layers Permit 19 Birch Road TOWN OF SOUTH WI N DSOR
DEPAItTTvi NT OF POL6TION CONTROL
South Windsor, Connecticut
DRAIN LAYER'S PE
RMIT N? 330
a 19 i'.
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at ij -:;f xF of 44) on the
'iA.0 A tt side, between . L. t-,fit a `to"sit An.:i Jt"&ti trvot
at premises owned by--
whose address is
and to Lay House Drain, Repair House Drain, Lay Main, Other
for occupancy or use,
with :y, r Family Units, with acres.
Type of Sewage to be connected under this permit:
(SANITARY SEWAGE INDUSTRIAL WASTES, OR
Connection will be made with
Permit to be issued to
the holder of Drain Layer's License No._ ':. ,i=d;'. Permit will expire on sal v* s ! ` 19 =z.
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 ` *-r tO a d haakfin antic -;PAlso to
Una 601m t joist Plastic Dix cave prffldkity of W*jj
Signed __ -..�_ •r a
Connection Charge Paid �',.3}+;i Licensed Drain Layer
Tax Collector (Sig) issued by
Permit Fee: Paid $.1 >;
6
INSPECTION:
INITIAL t' ,..,,. (Sig)
FINAL ,.,. (Sig)
APPROVED I Q "44 j 7 1, (Date)
(Sig)
INSPECIFOR
N .
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H
i
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NOTES SOUTH WINDSOR POLLUTION CONTROL
Mor ro SCAI-C LOCATION 19 p� dg m 12aAD
0 0 OWNER L. 'p N d
�} v 34o -`— TYPE OF WORK Saf
DATE .� jd- 3 PERMIT ca PIPEa,"PGEas,
i4.7 '• INSTALLER Lp. %pq _ 2,cr
also)
INSPECTOR DRAWN BY