HomeMy WebLinkAboutDrain Layers Permit 684 Clark Street TOWN OF SOUTH Wi N DSOR
DEPARTMENT OF POLLUTION CONTROL BAP No.: _
South Windsor, Connecticut List No.: _4 9
DRAIN LAYER'S PERMIT NO 2169
LI-3 , 19
Pursuant to written applicatiorr,,!/permissX;,-k
hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at ��Q Y
on the
side, between
at premises owned by— n
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 ( ,, INDUSTRIA WASTES .( ), OR
CC Connection will be made with /�./)1 y/0
�-
Permit to be issued to r
the holder of Drain Layer's License No. Permit will dpire 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
�n
13 �
��/ll� Signed �A-
Conn ction Charge Paid I.icen§Ad ra ayer
Issued by
Tax CoReeter,
Permit Fee: Paid
INSPECTION: Check Number: 1� _
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR