HomeMy WebLinkAboutDrain Layers Permit 37 Bourbon Street TOWN OF SOUTH , WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List No.: _
DRAIN LAYER'S PERMIT p 3102
K , 19
Pursuant to written applic1 tior, permi sion is hereby ranted to the Licensed Drain Layer named herein to perform
the work indicated below at AB' &f
on the
` side, between
at premises owned by_ S,�
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 ( ), 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
rr
Signea
Connection Charge id °y()O' 6 U Licensed Drain Layer
Issued by
Tax Collector —
VV,,JJ'"'��JJ Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR (Sig)