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HomeMy WebLinkAboutDrain Layers Permit 22 Charing Road TOWN OF SOUTH WI N DSOR DEPARTMENT OF POLLUTION CONTROL gip No.: South Windsor, Connecticut List.No.: DRAIN LAYER',S PERMIT NO 1634 a 19� Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform the work indicated below at on the side, between y� at premises owned by/ �.t , a: � 4zec- 04 , /�I a try f Z Cz DV,c whose address is C i 1 A r`r�ar i?O C, 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 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 Connection Charge Paid oZ �- 7 9 Licensed Drain Layer e c-e 3 Issued Tax Collect �O © O Permit Fee: Paid $ INSPECTION: Check Number: INITIAL (Sig) tie)rn e QW h FINAL (Sig) APPROVED (Date) (Sig) PEC OR } .. ,N.-7 � I �v CHAR NOTES SOUTH WINDSOR POLLUTION CONTROL LOCATION OWNER - ► I C a ���i'a� �� TYPE OF WORK DATE PERMIT PIPE n INSTALLER INSPECTOR h a DRAWN BY L s'sK i