HomeMy WebLinkAboutDrain Layers Permit 1776 Ellington Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List No.: _
DRAIN LAYER'S PERMIT p 3257
1y�z 10`7' , 19 L c f
Pursuant to written applicatior, permission is ereby granted to the Licensed Drain Laye awed herein to perform
the work indicated below at aon the
side, between
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 permit:
SANITARY SEWAGE ( . ),-INDUSTRIAL WASTES OR (_ )
Connection will be made with
Permir.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
Signed
Connection Charge Paid yQQ.O d Licensed Drain Layer
Issued by
���, " Tax Collector
®� Permit Fee:. Paid $ _ 16`0�
INSPECTION: Check Number:_ /)�1
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR (Sig)