HomeMy WebLinkAboutDrain Layers Permit 185 Bourbon Street TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List No.: _
DRAIN LAYER"S PERMIT p 309
19
Pursuant to written appli atQior, perm.is 'on is hereby gran d t the Licensed Drain Layer named herein to perform
the work indicated below at 4 P m
side, bet een on the
at premises owned by L
whose address is
and to Lay House Drain, - Repair House Drain,
Lay Main, Other
for
' with occupancy or use,
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.
The undersigned Drain Layer hereby agrees to all the terms and conditions setPermit forth�on the permit and the reverse s9de
thereof. Applicant has received Town�Permit No.
for street excavation. and/or C H D Permit No.
SPECIAL CONDITIONS
Connection Charge Paid Signed
Licensed Drain Layer
Tax Collector Issued by
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL
(Sig)
Sig)
APPROVED (Sig)
(Date)
INSPECTOR (Sig)
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