HomeMy WebLinkAboutDrain Layers Permit 2815 Ellington Road TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List.No.:
DRAIN LAYER'S PERMIT NO i507
EPA 2a , 19 _
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at 2-5)5 on the
side, between
at premises owned by OSE ri+ 1>ES CAA)No:
whose address is
and to _ Lay House Drain, Repair House Drain, Lay-Main, Other
for Q Es I D L wr)A`' occupancy or use,
with Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE (X), INDUSTRIAL WASTES _( ), OR ( )
Connection will be made with - 11 I
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 Licensed Drain Layer
CA- %6-78 Issued by
Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL Q (Sig)
APPROVED (Date)
b A� / � �L (Sig)
INSPECTOR
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION 28/5
OWNER \5'6s- csc
TYPE OF WORK ec 4
DATE 2 /-7 PERMIT ISO7 PIPE PVC,
INSTALLER ►'eves i
INSPECTOR DRAWN BY