HomeMy WebLinkAboutDrain Layers Permit 21 Birch Hill Drive • TOWN OF S06TH WINDSOR
DEPARTMENT OF PO TION CONTROL
B/P No.:
South Win sor, Connecticut
_ '""-,,' List.No.: �O f
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DRAIN LAYER'S PERMIT
O 1439
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at BJ�Lt1' l ) L on the
side, between
at premises owned by ZZ WIAZ 4E Al Y QA/
whose address is
and to V_Lay House Drain, Repair House Drain, Lay Main, `Other
for _ I &:4'/ g1VTJA
occupancy or use,
with owi5 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. 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
Signed L-,.
W �
Connection Charge Paid ���� Licensed Drain Layer
Issued by
Tax Collector
al
Permit Fee:. Paid $ ®_
INSPECTION: Check Number: ) 6
INITIAL (Sig)
FINAL (Sig)
APPROVED •°/6' (Date)
CPO (Sig)IN ECT
N
Cl�AL
-� >6
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION 21 b I�'C E !
OWNER
TYPE OF WORK
DATE �? !o PERMIT PIPE
INSPECTOR G "i: DRAWN BY �. L_