HomeMy WebLinkAboutDrain Layers Permit 85 Brook Street TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL gip No.:
South Windsor, Connecticut —3P/ Ql
List No.: _ J
DRAIN LAYER'S PERMIT N? 2301
, 19
Pursuant to written applliicatior, permission i hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at 00 a1'714 on the
side, between
at premises owned by fi►vwi. J 1�1
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 , 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
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS
SignedA 04�', aw I
Connection Charge Paid yD0 D D Licensed Drain Layer
Issued by
Tax Collector
ow, Permit Fee:. Paid $ _,�`'_•(�._
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
N
15
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION S Y6Q
OWNER
TYPE OF WORK y ,l t,a
DATE 3 R 3-7-P PERMIT PIPE V�-
INSTALLER '
DRAWN BY
INSPECTOR S L