HomeMy WebLinkAboutDrain Layers Permit 191 Bourbon Street / ,. ., y, • v[�r,.X- e.m-vlry�[=o1h'"nS•"i'4.�S7T' 'q�� ,{
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TOWN . OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut BAP-No.:
List No.: _
DRAIN LAYER'S PERMIT 394
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Pursuant to written is tior, permission�is`"hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below`at �` ,
on the
side, betwee �
at premises owned by
whose address is,
and to , Lay"House Drain, Repair House Drain,
Lay Main, _Other
for
occupancy or use,
with y Family,Units, with
acres.
Type of Sewagd..to be connected under this permit:
SANITARY SEWAGE ( ), INDUSTRIAL WASTES .( ), OR
CoAvection 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.
for*street excavation. and/or C H D Permit No.
SPECIAL,CONDITIONS
i
Conne p Signea
Charge Paid Licensed Drain Layer
Tax Collector Issued by
�v p
Permit Fee: Paid $
INSPECTION: Check Number: '
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR (Sig)_
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