HomeMy WebLinkAboutDrain Layers Permit 2791 Ellington Road . TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List No.:
DRAIN LAYER'S PERMIT N? 2426
1 2 r
Pursuant to written applicatior, permission is hereby ranted t the Licensed Drain Layer named herein to perform
the work indicated below at ov` on the
side, between
n
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 ( ), 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 . 2I / Licensed Drain Layer
Issued by
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
I
N
i
F
Y
NOTES _ SOUTH WINDSOR POLLUTION C DITRO
LOCATION -
OW NKER c r
TYPE OF WORK S�Y� " �r,•,I� �-- ('�"�
DATE / PERMIT t't ? :API E l`'✓
INSTALLER
INSPECTOR S DRAWN BY