HomeMy WebLinkAboutDrain Layers Permit 69 Brian Road (2) TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL gip No.:
South Windsor, Connecticut
List.No.: _
DRAIN LAYER"S PERMIT No 1250
, 19
7
�Z
Pursuant to written applicaatiio�r, permission is hereby• ranted to he Licensed Drain Layer named herein to"perform
the work indicated below at #0-4 i12 6 � on the
side, betwe n
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 ( , INDUSW ), OR ( )
Connection will be made with �� /�/t
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 ermit No.
for street excavation.tCIA)��ONDITIO
j S. �J
�� 7—O /�/' O v 6�0 a
Signed
Connection Charge Paid /b` V Licensed Drain Layer
4 3 s Issued by
Tax Collector r
Permit Fee: Paid $ _ 'co
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
7, (Sig)
INSPECT
N
lly
311
c
N
NOTES SOUTH WINDS-OR POLLUTION-CONTROL
LOCATIO
C/ iE cY jf OWNER dUIJ J ee
TYPE OF WORK ,�2
DATE - - PERMIT / PIPE e C
INSTALLER
INSPECTOR EC/``/ DRAWN BY ,�`-