HomeMy WebLinkAboutDrain Layers Permit 121 Edgewood Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL gip No.:
South Windsor, Connecticut
List No.: C �
DRAIN LAYER'S PERMIT N? 1956
Ve� , 20 , 19 _
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at LdAe Wept! -7)r on the
side, betwee
at premises owned by (?h b Z e l.. eo
whose address is
and to Lay House Drain, Repair House Drain, Lay-Main, ,—Other p
for occupancy or use,
with -je, Family Units, with acres.
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.
SPECIAL CONDITIONS
is- ;26
WA � Signed
Connection Charge Paid y00, (� Licensed Drain Layer
r �
Issued by
Tax Collector /,9 d 6171
Permit Fee: Paid $ • 0__ }v
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED 2. —`2- (Date)
(Sig)
INSPECTOR
s, 7
,1
t„
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION ,
OWNER '
TYPE OF WORK
DATE ' •PERMIT PIPE:',
INSTALLER
INSPECTOR DRAWN BY