HomeMy WebLinkAboutDrain Layers Permit 150 Diane Drive s TOWN OF� SOUTH WI N DSOR ..
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List.No.:
DRAIN LAYER'S PERMITO36
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at fat Ifil on the
side
at premises owned by__
whose address is
s
and to Lay House Drain, Repair House Drain), I.ay Main, Other
for
occupancy or use,
with =0 0 Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE (Z ), INDUSTRIAL WASTES .( ), OR
Connection will be made with ffi lr �
—defft or
Permit to be issued to__ _ 'R.P* . jr*
the holder of Drain Layer's License No. Permit will expire on_ 14 Aim= 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 LYcensed Drain Layer
4pt s
Issued by
Tax Collector
Permit Fee: Paid $ _ 1-154
INSPECTION: Check Number:
INITIAL _i{ 1S' . •� (Sig)
FINAL l' (Sig)
APPROVED 11446 Z 1 (Date)
(Sig)
INSPECTOR
r
I
i
I
J
If fJ
iI
1
is
W
I
NOTES SOUTH WINDSOR POLLUTION CONTROL
,r
LOCATION I r
OWNER
TYPE Of WORK
DATE / ,, PERMIT 6 PIPE
INSTALLS
INSPECTOR. DRAWN BY