HomeMy WebLinkAboutDrain Layers Permit 12 Clover Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List.No.: __ 7
DRAIN LAYER'S PERMIT NO 1469
19
-Y
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at �� l'�D .�/�• ,�0� 43 on the
side, between/� y�
at premises owned by �I Idiom
whose address is
and to Lay House Drain, Repair House Drain, Lay Main, Other
for — -�/y-l.�( ,
�i occupancy or use,
with Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ()C, INDUSTRIAL WASTES ( ), OR ( )
Connection will be made with
Permit to be issued to ��E
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
Signed
Connection Charge Paid Q Licensed Drain Layer
Tax Collector Issued by
Permit Fee:. Paid $ __
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION �o-� L13 Clover Lr i ye.
OWNER
TYPE OF WORK ]+Ouse, Cvnne•e. 1 i� n
DATE PERMIT PIPE l v
INSTALLER
INSPECTOR C,T. DRAWN BY C.K