HomeMy WebLinkAboutDrain Layers Permit 2051 Ellington Road TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor,Connecticut
List No.: _
DRAIN LAYER'S PERMIT N? 2634
Pursuant to written application, permission is hereby grante to the Licensed Drain Layer named herein to perform
the work indicated below at '�U� I �/�-� fJ on the
side, between
at premises owned by
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 condiCions 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
r
Signed
Connection Charge Paid 4/00 •Q o Licensed Drain Layer
7, Issued by
Tax Collector
Permit Fee: Paid
INSPECTION: Check Number:
t�
INITIAL (Sig)
FINAL (Sig)
" APPROVED (Date)
(Sig)
INSPECTOR