HomeMy WebLinkAboutDrain Layers Permit 62 Dogwood Lane TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List.No.: _6151 S _
DRAIN LAYER'S PERMIT NO 1613
19 -�cf
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to-perform
the work indicated below at 6, 2 - -, . j) y on the
side, between
at premises owned
whose address is_ .q AM C
and to X_Lay House Drain, Repair House Drain, Lay-Main, Other
for
with (��,� occupancy or use,
Family Units, with acres.
Type of Sewage to be connected under this permit-.
SANITARY SEWAGE (A), INDUSTRIAL WASTES ( ), OR ( )
Connection will be made with
Permit to be issued to
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 sec 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
J9
Signed
Connection Charge Paid I, Z,d cen ed Drain Layer
# ��
Ta Collecto r Issued by
Permit Fee: Paid $ �__
INSPECTION: Check Number:
INITIAL (Sig)
FINAL _ (Sig)
APPROVED Z (Date)
(Sig)
INSPECTOR
v
N
1
o y
�Pn ,
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER
TYPE OF WORK
DATE PERMIT/ PIPE
INSTALLER/ r.
INSPECTOR DRAWN