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HomeMy WebLinkAboutDrain Layers Permit 7 Dart Hill Road TOWN OF SOUTH WI N DSOR DEPARTMENT OF POLLUTION CONTROL gip No.: South Windsor, Connecticut List.No.: DRAIN LAYER"S PERMIT N? 1654 119 Pursuant to written applicatior, permission is hereby granted to the Licensed Drain ayer med herein to erform the work indicated below, at tr G a -3 n the side, between P71 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 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 — Z —7� Licensed Drain er <aax �� 1r' Issued by Collector rr Permit Fee: Paid $ _�.Z V INSPECTION: Check Number: Z© INITIAL (Sig) FINAL (Sig) APPROVED a (Date) (Sig) INSPECTOIr- � s Lo- 1 ry ER-1 2� Z J J i 03 sBe^d NOTES n SOUTH WINDSOR POLLUTION CONTROL LOCATION T . --ff OWNER TYPE OF WORK DATE - PERMIT PIPE (o''P✓(:,� INSTALLER INSPECTOR 4 6 (- DRAWN BY D, L'<-K