HomeMy WebLinkAboutDrain Layers Permit 40 Diane Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List.No.: 4=
DRAIN LAYER'S PERMIT NO 2024
19 c+�
Pursuant to written applicatior, permission i hereby granted to the Licensed Drain Layer named herein to"perform
the work indicated below at_ �` on the
side, between
at premises ted 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:d
SANITARY SEWAGE ( ), INDUSTRIAL WASTES ( ), OR ( )
Connection will be made with
Permit to be issued to
f
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 !� �[/ Licensed Drain Layer
Ar4,el
Issued b
ax Collector
Z
1 0j Permit Fee: Paid $
INSPECTION: Check Number: 9
INITIAL (Sig)
FINAL (Sig)
APPROVED .. (Date)
INSPE OR (Sig)