HomeMy WebLinkAboutDrain Layers Permit 110 Brookfield Stree TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT
O 26+77
Pursuant to written applicatior, permission is hereby grpted to the Licensed.Drain Layer named herein to perform
.the work indicated below at 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 ( ), 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 ro"all the terms and conditionsset 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
=f ai0� 1�-�-Cf 09-
Signed
Connection Charge Paid� ///'00-d y Licensed Drain Layer
CJL t Issued ued by
4- dT'ax Collector
Permit Fee:. Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR (Sig)