HomeMy WebLinkAboutDrain Layers Permit 1175 Ellington Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List.No.: _
DRAIN LAYER'S PERMIT / Me
N. 1281
, 19
Pursuant to written applicatior, permission is
hergranted toyt�he� icens d IIr La er d herein to-perform
the work n cated low at f�/I /GL!
n the
0 side, be / O
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 }, INDUS `AL W ), 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 LibAsed Plain Layer
Issued by
Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR (Sig)
75�1�
TW2
pow , 741
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