HomeMy WebLinkAboutDrain Layers Permit N/S Deming Street (2) TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL gip No.:
Yy ' South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT O 65
, 19
Pursuant to written appliiccJatti f , peR fission is hereby grante�tpo h—e Licensed Drain Layer named herein to perform
the work indicated below at
on the
side, between I
at premises owned by
whose address is
and to Lay House Drain, Repair House Drain, Lay Main, Other
for .C.r'.� occupancy or use,
'r with Family Units, with acres.
Type of Sewage to be connected under this permit: ti 1
SANITARY SEWAGE `, INDUSTRIAL WA (/I ), OR
Connection will be ma with
a
Permit to be issued to
the holder of Drain Layer's License No. Permit will expire on 19
The undersigned D;ain 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
i Signed
Conne ' n Charge Paid 1 o71 / Licensed Drain Layer
A.;0.
Issued by
Tax Collector f
Permit Fee:. Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL - (Sig)
APPROVED (Date)
(Sig)
INSPECTOR