HomeMy WebLinkAboutDrain Layers Permit 355 Diane Drive TOWN 0� �$UTH� �V, Nb OR
DE'PARTMEN�.-,QF.,,PiOL-LUTION CONTROL
Soutfi',Wi'ndsor; Connecticut
DRAIN LAYER`• PERMIT ,. 24
on , 19
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at ► on the
O 44NIUs side, between
at premises owned by N&W-SMANIANK -
whose address is f '
and to Lay House Drain, Repair House Drain, Lay Main, Other ,
for occupancy or use,
with FamilyjUnits, with acres.
Type of Sewage to be connected under this permit:
(SANITARY SEWAGE IiDUSTRIAL WASTES, OR
Connection will be made with
j .
I Pe'iin it-.to be'issued.to - A.di
fin
the holder ofi Drain Layer's License No. � Permit will expite on 19 Cap
The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on-the permit and the reverse side:.,
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation:
SPECIAL CONDITIONS
r
Signed
Connection Charge Paid s 3$_" Licensed Drain Layer
(Sig) Issued byt
Tax Collector
P m�it F Paid S
INSPECTION:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
Sig)
' INSP��CTOR