HomeMy WebLinkAboutDrain Layers Permit 121 Bourbon Street TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List No.:
DRAIN LAYER'S PERMIT N? 2678
19
Pursuant to written,aica "ion is hereby grated"to the Licensed Drain Layer named herein to perform
the work indicated below at � `cam/
on the
side, between
/
At premises owned by
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 ( ,j, 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
Connection Charge Paid 46).OU Licensed Drain Layer
Issued by
Tax Collector
Permit Fee: Paid $ A ��/D�� —��2
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR