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TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT
O 327$
/7 , 19
A r7TD 9 Ian Rd
Pursuant to written app icatior, permiss' n is hereby rantedd to the Licensed Drain Layer named herein to perform
the work indicated below at IC�-� on the
side, tween
at premises owned b l tf
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 ( ), 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
�Q�< � d � Signed C nnection Charge Paid n Licensed Drain Layer
7 u Issued by
x C ec�gr
Permit Fee: Paid $ d 6_
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR