HomeMy WebLinkAboutDrain Layers Permit 479 Clark Street (2) TOWN OF SOMAI D W N SOR
DEPARTMENT OF POLLUTION CONTROL gip No.: _
South Windsor, Connecticut
List No.: S—
DRAIN LAYER'S PERMIT Na 546
Al r-91 29 ' 19 74
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at 479 on the
c�wn< s-ide, betweenD*WiAx s 4,18tt Valley
at premises owned Tijn'rinM f nVi nglae
whose address is amz-t
and to XLay House Drain, Repair House Drain, Lay Main, Other ,
for !.q)ftXti 1 occupancy or use,
with os Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( � ), INDUSTRIAL WASTES .( ), OR
Connection will be made with siy, 46 -11agg lc' tid jil2a
Permit to be issued to Jeika Lnmzoa
the holder of Drain Layer's License No. t? 9 'r Permit will expire on Ju t 1). 19 L4
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 °Ft3✓" Licensed Drain Layer
Lo Assis Issued by ,, `,. 3' K1ektof*atA#r Jrf,
Tax Collector
Permit Fee:. Paid $ _
INSPECTION: Check Number:
INITIAL /_ L�,/ (Sig)
FINAL '"' 1 (Sig)
APPROVED / (Date)
C-7 �;; -
D INSPECTOR g
� ti
M r
Lol"ll
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION /-/ 79 C L A.P T
OWNER .I C
TYPE OF WORK r- L Tr�19Z
DATE 2q ERMIT PIPE jS Vf
INSTAL R A
INSPECTOR -X, DRAWN BY
TOWN OF SOUTH WIN•DSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: t4
BUILDING ADDRESS -s T-
STREET
SUBDIVISION:
NORTH ARROW
I !
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I I •'�' I � � I r .n�'�R i �� i �1 �
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (P )
STREET
DRESS SIGNATUR
DATE
TOWN STATE ZIP INSPECTEDY TOWN
DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER