HomeMy WebLinkAboutDrain Layers Permit 53 Clinton Drive TOWN 0F. SOUI tI WI NDSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut
DRAIN LAYER'S PERMIT xo 291
x. 19
z
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at Z _ 1+9 ' on the }
3-
side, between f'
...,
at premises owned by 7` , �� �' °1<'
whose address is 3
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, INDUSTRIAL WASTES, OR
Connection will be made with
"a
Permit to be issued to r "`
the holder of Drain Layer's License No. 134 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. j#
for street excavation.
SPECIAL CONDITIONS
Signed �.
Connection Charge Paid $ Licensed Drain Layer
(Sig) issued by Y
Tax Collector
Permit Fee: Paid $
INSPECTION:
INITIAL (Sig) =i
FINAL (Sig)
APPROVED 110 July 1 (Date)
(Sig)
INSPECTOR x
N
2
f
; q
r
91.1 Fr ro No2rNw�sr
e.o2N E2 tiouSE "`}8
NOTES SOUTH WINDSO/JR POLLUTION CONTROL
SGRC.0 t"� 4� �P�2 LOCATION s3 01-w-o/J Ae i✓F 4 Lor
QOWNER QrTo C-t ,4 Ana
3►.s TYPE OF WORK Sewc&
DATE o -b - 3 PERMIT z I PIPE&" r-nsr.
INSTALLER K w9- 134)
INSPECTOR DRAWN BY