HomeMy WebLinkAboutDrain Layers Permit 174 Brook Street • TOWN OF SOUTH WI N DSOR
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DEPARTMENT OF' POLLUTION CONTROL B/P No.: �
South Windsor, Connecticut (�
List.No.: /Z_
DRAIN LAYER'S PERMIT N? 1351
��-2 3_. , 19
Pursuant to written application, ermission is hereby gr nt to the Licensed Drain Layer named herein to perform
the work indicated bel 16 on the
side, between
at premises owned by
whose address is
and to (Lay House Drain, Repair House Drain, Lay-Mara, Other ,
for
occupancy or use,
with Family Units, with - acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE (, INDUSTRIAL ASTES
Connection will be made with
�� y
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
,A&FCZW � 1"& &A
Connection Charge Paid Licensed Drain Layer
Issued by
Tax Collector ('�
Permit Fee: Paid $ ?� A
INSPECTION: Check Number: • ��
INITIAL (Sig)
FINAL (Sig)
APPROVED 'Z -7 (Date)
(Sig)
INSPECTOR
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303.E
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170
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