HomeMy WebLinkAboutDrain Layers Permit 68 Deming Street TOWN- Of SOS WI N DSOR
DEPARTM6.NT OF POL�W_TION CONTROL
South Windsor, {o4 ecficut
DRAIN LAYER'S- PERMI-T0 252
19
Pursuant to written application,permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated. below at 3
�� on the
side, betwwei en
at premises owned bye_es 'e •y.' " fir. t
whose address is - 4t
and to Lay House Drain, Repair House Drain, Lay Main, Other
for_ a u:t',•1 u44
occupancy or use,
withr ► Family Units, with acres.
Type of Sewage to be connected under this permit:
(SANITARY SEWAG INDUSTRIAL WASTES, OR
}
Connection will be made with •` ���`: � �,;:'_ : . ;�.��f A
Permit to be issued to
-the holder of Drain Layer's License No. Permit will expire on
The undersigned Drain Layer hereby agrees to-all the terms and conditions set forth on the per—�iitande reverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS
t
Z"t �Signed
Connection Charge Paid,3 :fg icensed Drain Layer
t _(Sig) Issued by. ir7 ,;*
Tax Collector
Permit Fee: Paid z
INSPECTION:
INITIAL
� (Sig)-;,
FINAL 7"ju .:
(Sig)
APPROVED (Date)
z
`INSPEECTOR (Sig)`
40
to
N
v '
�4
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION G 8 P m "v S f
OWNER 2 n
TYPE OF WO Sevvac Co,vNec iv
DATE �� PERMIT s' PIPE
INSTALLER , 'Al Z
INSPECTOR`i c 2 e-_ "` DRAWN BY,,