HomeMy WebLinkAboutDrain Layers Permit 35 Brook Street TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List.No.:
DRAIN LAYER'S PERMIT NO 2011
19
Pursuant to written applicatior, permission is herebygranted to the Licensed Drain Layer named herein to perform
the work indicated below at ��O �1�. on the
side, between f
at premise owned by Z3 f &?Z- Ash e�
whose address is "
and to Lay House Drain, Repair House Drain, Lay-Main, �_Other ,
for /1 occupancy or use,
with Family Units, with _,�• acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE (, ec, INDUS IAL WASTES ( ), OR ( )
r�
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
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS
�`ot G
Signed
Connection Charge Paid (� 9, Od Licensed Drain Layer
Tax Collector Issued by
Permit Fee: Paid $
INSPECTION: Check Number: 3 7Q
/Ili%/J /'fa v•'��°
INITIAL (Sig)
FINAL /7 (Sig)
APPROVED i �C.� (Date)
(Sig)
INSPECTOR
N
I
f J n
I
.i N .3S c,o, � � -� G
�,
E A-Sv
�E ^/d a
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION ,
OWNER
TYPE OF WORK 6 9 d,. Owl
DATE,f• n_70 PERMIT 2n PIE 6 "
INSTALLER
INS CTOR DRAWN BY
r � u
y y r
� r
y �_