HomeMy WebLinkAboutDrain Layers Permit 101 Clearview Drive TOWN OF SOUTH Wi N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List No.:
DRAIN LAYER'S PERMIT NO 2548
l 19
Pursuant to written ap lid„„atior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at b6
on the
side, bet7n
at premises owned by
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 per
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
IF
Signed
Connection Charge Paid ° �, Licensed Drain Layer
�� /Yt l( f)l GlitpJ�f Issued by
Tax Collector
V'.
Permit Fee Paid $
INSPECTION: Check Number: y77
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR