HomeMy WebLinkAboutDrain Layers Permit 181 Dogwood Lane TOWN OF SOUTH WINDSOR
(� DEPARTMENT OF POLLUTION CONTROL
0 Q B/P No.:
�R 1 South Windsor, Connecticut S List No.: -310
t�
DRAIN LAYER"S PERMIT NO 2070
, 19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at d J d ri toye on the
side, between -
at prem's s owned by // odz 2 lee,k
whose address is
and to Lay House Drain, Repair House Drain, Lay Main, Other
for 4 a occupancy or use,
with Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( �NDUS L 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.
SPECIAL CONDITIONS
'/ _ Signed -:��CfzS 1,A
Connection Charge Paid '1�6 icensed Drain Layer 01
Issued by -yXz
Tax Collector o70 1)0 S'Permit Fee: Paid $
INSPECTION: Check Number: 1 -
INITIAL (Sig)/ /�rtS SC�J!1 d /GA r�
FINAL (Sig)(`I'7 a
APPROVED (Date)
(Sig)
� INSPECTOR � T�
Zv
14o
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER
TYPE OF WO 5-, 11- 4-
DATE 57-- 0-5=90 PERMIT PIPE
INSTALLER 7-A
INSPECTOR r% DRAWN BY /47-51,b