HomeMy WebLinkAboutDrain Layers Permit 2849 Ellington Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List No.: _
DRAIN LAYER'S PERMIT N� 2445
.fad `J , 19 �
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Pursuant to written applicatior, permission is hereby grantel to the Licensed Drain Layer named herein to perform
the work indicated below ate
on the
side, between -� f
at premises owned
i
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
r
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
a 7
/q 91 Signed
Connection Charge Paid Licensed Drain Layer
4�ixCollector
]L(P. Issued by
Permit Fee: Paid $
INSPECTION: Check Number:
_ INITIAL (Sig)
FINAL (Sig)
-
—(Date)
�, INSPECTOR (Sig)
1
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i
1 J Y
f ,
ROTES SOUTH WINDSOR POLLUTION O�TTR L r
LOCATION
OWNER
TYPE OF WORK air • S��v -
DATE PERMIT,- WL/' PIPE
INSTALI.�ER oVP�
INSPECTOR DRAWN BY .