HomeMy WebLinkAboutDrain Layers Permit 340 Brookfield Stree TOWN OF SOUTH Wi N DSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor,Connecticut B/P No.:
List No.:
j
DRAIN LAYER'S PERMIT N? 2978
Pursuant to written applicatior, permission is hereby gr nted to the Licensed Drain Layer named herein to pt
the work indicated below at y� /
0
side, between
at premises owned by ,L -
whose address is
and to Lay House Drain, Repair House Drain, Lay-Main, - - Other
for
occupancy or
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. Pe{mit will expire on 19_
The undersigned Drain Layer hereby agrees to all the terms and condition"set forth on the•permit and the-re
verse side
thereof. Applicant has received Town Permit No. and/or C'H D Permit No.
for street excavation.
SPECIAL CONDITIONS
Signed
Connect-ion Charge Paid QQ•QU Licensed Drain Layer
�- li Dl�'A Issued by
� Q n Tag Collector
%`�� Permit Fee: Paid $
INSPECTION: Check Number: �labd
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
e,
(Sig)
INSPECTOR