HomeMy WebLinkAboutDrain Layers Permit 51 Edwin Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List No.: _
DRAIN LAYER'S PERMIT N? 2:679
�y
19 `
Pursuant to written appiicatior�,�p"ermission i\e eby granted to the Licensed Drain Layer named herein to perform
the work indicated below at-,.
on the
side, between
at premises owned by �3[
whose address is
and to Lay House Drain, Repair House Drain, Lay-Main, Other
for
occupancy or use,
with. Family Units, with
acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( j, 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
Signed
Connection Charge Paid 6� ,6 0 Licensed Drain Layer
Issued by
•Tag Collector
Permit Fee: Paid
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR
(Sig)