HomeMy WebLinkAboutDrain Layers Permit 685 Clark Street 'TOWN OF SOUtw DUI N DSOR
DEPARTMENT OF ;PO L UTIdN CONTROL gip No.:
South Windsor, Connecticut
List.No.: _
DRAIN- LAYER'S PERMIT O 61
19
Pursuant to written applicatior, permission-is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at r on the
side, between r
at premises owned by
whose address is maim
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 j, INDUSTRIAL WASTES .( ), OR ( . )
Connection will be made with
Permit to be issued to
the holder-of Drain Layer's License No. � P'ermit'wilt.expire on _ I
The undersigned Drain Layer hereby agrees to a•11 the'terms and'conditions'set forth on"the permit and the reverse s
thereof. Applicant has received Town Permit No. and/or C H D Permit No:
for street excavation..
SPECIAL CONDITIONS
Signet
Connection Charge Paid _ Licensed Drain Dyer
Now
Issued by
Tax Collector
Permit Pee:.Paid $ASEAN__
INSPECTION: Check Number:
INITIAL ✓"�+� �` fr 00�rq _ (Sig)
FINAL _ 7. (Sig)
APPROVE r (Date)
f�� „" '��' . Sig •
w �
N
II i
44
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION (r -j K sT-
OWNER ,9�,► �� ' ��'
TYPE OF WOltKS�wlzx f3 "���
DATE ' PERMIT e'/ PIPE ril c
INSTA R
INSPECTOR DRAWN BY