HomeMy WebLinkAboutDrain Layers Permit 19 Brian Road ,
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' TOWN OF SOUTH WI N DSOR '
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"{ DEPARTMENT OF POLLUTION }CONTROL Big No.. '
South Windsor, Connecticut
_ List No ,-
DRAIN_ LAYER'S PERMIT P_ , 704
4 ., 19
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Pursuant to written applicauor, permission lsr hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at `' x {
on the
side, between `
at premises owned by ,,,lss � ��
whose address is
and to` Lay House Drain; Repair House Drain, Lay Main, " = Other . _
for r' _�����,-_,�,�,_X.,�.�-,
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occupancy or use,
with Family LJnitst with t
acres
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Type of Sewage to be connected under this permit
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SANITARY SEWAGE INDi7STRIAI, WASTES_ .-.. O _ °( )
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Connection will be made with "
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Permit to be issued to" - . r' ;
the holder of Drain"I ayer's License No _ permit will expire on _ I9 .,
The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on the permit and the reverse side_: 1 N
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thereof. Applcant'has received Town Permit No. and/or C HD Permit No }
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for sweet excavation: r
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.;`SPECIAL CONDITIONS
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Signed • � f f
Connection Charge Paid �Q�► 4 *►' 1
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C li' 16« '� Issued by 41iz , »i ,�=
Tax Collector
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Permit Fee: Paid _ w
INSPECTION: Check Number: f"
INITIAL '� io / SA, , , (Slg)e
FINAL f `h__ W A,I' .= , (Sig)'
APPROVED b '� �
(Date)
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INSPECTOR (Sig)
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