HomeMy WebLinkAboutDrain Layers Permit 770 Clark Street �. TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
� South Windsor, Connecticut B/P No.:
List No.:
DRAIN LAYER'S PERMIT
52
MV , 19 74 .
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at _ on the
"at side, between ? �er�;�s x_t,:,� Val 3ex
Rd-
at premises owned by
whose address is mme
and to XLay House Drain, Repair House Drain, Lay-Main, Other
for residential
occupancy or use,
with Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE (X ), INDUSTRIAL WASTES .( ), OR ( )
Connection will be made with ad Y (4) i J&Ch At anti .I,Q
Permit to be issued to
the holder of Drain Layer's License No._ - '-_--a � Permit will expire on 19
The undersigned Drain Layer hereby agrees to aTI 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 Licensed Drainf Layer
Issued by
Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
-" (Sig)
INSPECTOR
r i
o
N
r ,
r
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION 70 C 4 q K j;-
OWNER /-7t/o7—
TYPE OF WORK s�weR L�ERaz
DATE G' PERMIT s' PIPE Pvc,
INSTAL
INSPECTOR DRAWN BY