HomeMy WebLinkAboutDrain Layers Permit 160 Brook Street TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List.No.: _
DRAIN LAYER'S PERMIT NO 1371
5 , 19�
Pursuant to written applicaattiior, permission is hereby ted to the Licensed Drain Layer named herein to perform
/
the work indicated below at , 6
�-�
on the
side, between &d e-11el
at premises owned by �' r -
whose address is
J�&eI-
and to Lay House Drain, Repair House Drain, Lay ain, Other
for occupancy or use,
with Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( INDUSTRIAL ), 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
Signed
Connection Charge Paid Licensed Drain Layer
Issued by
Tax Collector f`_
Permit Fee: Paid $
INSPECTION: Check Number: —
INITIAL (Sig)
FINAL (Sig)
APPROVED ,�� — (Date)
(Sig)
INSPECTOR
V/
,146 6 �''��
3,2' 3Z i
('4). 3
T-L�
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3'
NOTES SOUTH WINDSOR POLLUTIO NTROL
LOCATION
OWNER e- f /le
TYPE OF WO v ' >
DATE - P RMIT 1 PIPE 07
INSTALLER ,
INSPECTOR G DRAWN BY
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