HomeMy WebLinkAboutDrain Layers Permit 240 Brookfield Stree TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT 0 3562
y , 19 '
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at , -/d� /'f on the
side, between-
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 ( j, 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
l Signed '
Connection Charge Paid ����� (� Licensed Drain Lay r
_a�ze-, Issued by
Tax Collector
v Permit Fee: Paid $
INSPECTION: Check Number: �D) "
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR