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HomeMy WebLinkAboutDrain Layers Permit 69 Dart Hill Road TOWN OF SOUTH WINDSOR DEPARTMENT OF POLLUTION CONTROL B/P No.: South Windsor, Connecticut List.No.: DRAIN LAYER' S PERMIT ND 1690 -AcI ) 19 Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform the work indicated below at-6 C1 C)C, {P� k � on the side, between at premises owned by C © C ' G� I e—r' 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 ( ), INDUSTRIALL WASTES ( ), OR ( ) Connection will be made with_ t, ! y Permit to be issued to M S 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 {/fit Signed Connection Charge Paid — LA y 12 icensed Dr n ayer 1 1% Issued by Tax Collector o Permit Fee P id $ '' INSPECTION: Check Number: Tom_ INITIAL (Sig) FINAL (Sig) APPROVED J.., r (Date) . � (Sig) INSPECTOR Y N CA I I i NOTES W �� �.� �-' SOUTH WINDSOR POLLUTION CONTROL LOCATION 6 a �1` OWNER TYPE OF WORK DATE PERMIT I C '20 PIPE C INSTALLER C ej t INSPECTOR DRAWN BY f-';