HomeMy WebLinkAboutDrain Layers Permit 56 Brewster Road oVWN ur wuIh WINDSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut
DRAIN LAYER'S PERMIT No 269
I9
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at # ; t"�L on the
side, between
at premises owned by
whose address is
and to L 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 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 Paid $ Licensed Drain Layer
(Sig) Issued by gt
Tax Collector
Permit Fee: Paid $
INSPECTION:
INITIAL (Sig)
FINAL (Sig)
APPROVED / „� (Date)
(Sig)
jP INSPECTOR
N
C <Gs
E;
ti
s�
e
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATIONa 55r
OWNER
TYPE OF WORK
DATE . /6 PERMIT PIPE A)C—
INSTALLER
INSPECTOR DRAWN BY