HomeMy WebLinkAboutDrain Layers Permit 30 Elizabeth Street TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List-No.:DRAIN LAYER'S LAYER',S PERMIT Np 1972
9 , 19
Pursuant to written applicatior, permission is here/by granted to the Licensed Drain Layer named herein to perform
the work indicated below at �U / Zrt S� �A ✓ - on the
side, between T
at premis owned by �tiP O Cl, N
whose address is dv►1
and to Lay House Drain, Repair House Drain, Lay-Main, Other
for O,p�.,.,�.e_.,. �" occupancy or use,
with Family Units, wit acres.
Type of Sewage to, beconnected under this permit: _ 2
SANITARY SEWAGE ( �),dINDUSTRIA WASTE ( �, OR ( )
Connection will be made with - J C_
Permit to be issued to C�L�YL
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 q6 0 . Licensed Drain Layer
t9le' Issued b
ax Collector
. Permit Fee: Paid $ _
INSPECTION: Check Number: �G
INITIAL (Sig) C'_a Q.-
FINAL (Sig)
APPROVED jl 2' 455, (Date)
(Sig)
INSPECTOR