HomeMy WebLinkAboutDrain Layers Permit 106 Dogwood Lane TOWN OF` W 1 - VV t N "
D�S��
DEPARTMENT OF .`PO1 LOTION CONTROL
�` rd •,.ps South Windsor, Connecticut
40 41 sr 410 ZZ3
URAIWLAYER'S PERMIT O
_
19 `
Pursuant to.Written application, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at 44JO0 41 L4 A46 on the
side, between Y ,.. .,
at premises owned by '_ "" .. <f :. 4 1014
`- whose addres is"
and to Lay House Drain,} Repair House Drain, Lay Main, _Other
for Ali d t � #�--Y
occupancy or use,
V
with k } =" •.' Family Units, with acres.
1. -
Type of Sewage to be connected under this permit:
SANITARY SEWAGE; 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 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.
`i
SPECIAL CONDITIONS �a
Signed
Connection Charge Paid, Licensed Drain Layer
>'4:• r', (Sig) Issued by
Tax Collector -
Permit Fee: Paid $ y:
INSPECTION: '..:.
INITIAL , - (Sig)
FINAL '"lr'I (Sig)
APPROVED 01 �e�r+1 197,a! v (Date)
(Sig)
IN .:.0 O'
r
I
N
q�--
7'
/7•
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER
TYPE OF WORK
DATE PERMIT PIPE
INSTALLER
INSPECTOR DRAWN BY f.