HomeMy WebLinkAboutDrain Layers Permit Ellington Road and S {
'OWN OF SOUTH WINDSOR
fx DEPARTMENT OF POLLOTION CONTROL
South Winds"or, Cronncticut
s
DRAIN LAYER'S PERMITO 12►�
r , 19
Pusuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at 3•. 11ftat" ilk N
-r
ittw.socum or - an %64 "d suloft lb"s
at premises owned by
whose-address is F. .
IF
and to Lay House Drain, Repair House Drain, 4V=Lay Main, —other
for � UO3. . occupancy or use,
with_ `t 48) 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 t
the holder of Drain Layer's L tense No. Permit will expire on - 19
The.undersigned Drain Layer hereby agrees to all;[he ternis_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 CONDITION ' b"hRW* Maw
+ Aftift Am Aowto afteet
a.
► $ t Y
F
e AS ROM1 a
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Signed WMIM Iffy
J
Connection Charge Paid t Licensed Drain Layer —{ f
(Sig) Issued bys
Tax Collector
Permit Fee: Paid #
INSPECTION. Chock: s
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)