HomeMy WebLinkAboutDrain Layers Permit 105 Bourbon Street TOWN , OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT
0 3128
, 19
Pursuant to written appli a 'or permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at - �d" (�9• 10,5 /= l J���1717� 1 on the �p
side, between /p
at premises owned byS>'<
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 I:ayer'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
01,
Signed
Connection Charge Paid Licensed Drain Layer
Issued by
�,Q'- .Tax Collector
Permit Fee: Paid $ _� Oct
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR (Sig)