HomeMy WebLinkAboutDrain Layers Permit 60 Clover Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List No.: _ s 0
DRAIN LAYER'S PERMIT N? 1416
IIA45 _70Z , 19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at t'n �.O V�2 Q1VE LDT � .� � on the
/ RT,4 side, between at premises owned by " ,e
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 (K), INDUSTRIAL WASTES .( ), OR ( )
Connection will be made with
Permit to be issued to VV y /V ON <Zk 1/C!n DAI C
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 an the reverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS
C
Signed
Connection Charge Paid . Z0� Licensed Drain Laye
�If Issued by
Tax Coll ctor
Permit Fee: Paid $
INSPECTION: Check Number:_
INITIAL (Sig)
FINAL (Sig)
t
APPROVED m-Zz - 7r (Date)
(Sig)
INSPECTOR g
N
i
I
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION 3 C 70VER 77.
OWNER U w- R
e�o(e-Z TYPE OF WORK RO US E- Co !Q rJ
DATE6-22-' g PERMIT ILl 6 PIPE pV
INSTALLER
INSPECTOR DRAWN BY