HomeMy WebLinkAboutDrain Layers Permit 12 Carey Lane TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT N? 2543
19
Pursuant to written applicator, perm`issi s hereby granted to th Licensed Dr in Layer named herein to perform
the work indicated !{�! / � .5 — ss27 (�
below at �o�. T` �lit�L on the
side, between
�
at premises owned by y //�
whose address is
and to Lay House Drain, c 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 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
c)pq
n , Signed
Connection Charge Paid g/Wd (`y Licensed Drain Layer
Issued b
-,Tax Collector V y /
Permit Fee: Paid $ _L6
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR