HomeMy WebLinkAboutDrain Layers Permit 126 Country View Dri TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List No.: _
DRAIN LAYER'S PERMIT
O 2671
19 O�c .
Pursuant to written LZapplic tior, permission is hereby granted o the Lice sed Drain Layer named herein to perform
the work indicated below at �J J
on 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 (. j, INDUSTRIAL WASTES .( ), OR
Connection will be made with
Permit 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 40j .U� _ Licensed Drain Layer
Issued by
Tax Collector
Permit Fee:. Paid $ _1,!57 ,�
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR