HomeMy WebLinkAboutDrain Layers Permit 171 Bourbon Street TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List No.: _
DRAIN LAYER'S PERMITp 3105
r 19
Pursuant to written applicat or, per 'on is hereby, grant d to the Licensed Drain Layer named herein to perform
the work indicated below at � t ,
on the
side, between J/
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 ( ), INDUSTRIAL WASTES .( ), OR ( )
Connection will be made with
f
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
J1/53
Signed
Connection Charge Paid lley .6o Licensed Drain Layer
Issued by
Tax Collector —
uUu�Y/Y Permit Fee:. Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR (Sig)