HomeMy WebLinkAboutDrain Layers Permit 84 Bourbon Street TOWN OF
SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List No.: _
DRAIN LAYER'S PERMITp104
19 �3
Pursuant to written appl'c tLt
'1ioDr, permission is hereby granted to th Licensed Drain Layer named herein to perform
the work indicated below at 7- 'X - 0
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
s 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
Y
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS
Signed
Connection Charge P id '7 bD D U Licensed Drain Layer
� 2.1L Issued by
Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number: 5y�
INITIAL (Sig) ���
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR