HomeMy WebLinkAboutDrain Layers Permit 45 Clover Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
-1 1. List No.: _
DRAIN LAYER',S PERMIT - -
N° 1513
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to erform
the work indicated below at 1 p
—�—er-.. �-T ��p
on the
side, between
at premises owned by
whose address is U
and to K_Lay House Drain, Repair House Drain,
Lay Main, Other
for ��°
with eNa occupancy or use,
Family Units, with
Type of Sewage to be connected under this permit: acres.
SANITARY SEWAGE (X, INDUSTRIAL WASTES .( ), OR ( )
Connection will be made with
Permit to be issued to R ,�
the holder of Drain Layer's License No. Permit exire on The undersigned Drain Layer hereby, agrees to all the terms and conditions s tlforth on the permit and the reverse s�de
thereof. Applicant has received Town Permit No.
for street excavation. and/or C H D Permit No.
SPECIAL CONDITIONS
Connection Charge Paid Signed Ayy��er �(�"
Lic ed Drain -
- 9_Z1_�
Tax Collector Issued by
Permit Fee: Paid
INSPECTION: Check Number: Z v D
INITIAL
(
FINAL (Sig)
(Sig)
APPROVED 'J Ir (Date)
INSPECTOR (Sig)
/ f
f 84
S�aEiyr?c K..
i
PAD
s; Us
NOTES SOUTH WINpSOR POLLUTION CONTROL
Wt% Zo--o— LOCAT ION GoT Z Co
OWNER
TYPl OF WO %wL _
DATE - 1 _ PERMIT !_5 PIPE '�
15T&WR RegD -
INS PRCTOR DRAWN BY