HomeMy WebLinkAboutDrain Layers Permit 1250 Ellington Road f
TOWN OF SOUTH WI N DSOR
4
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List No.:
DRAIN LAYER'S PERMIT NO 1677
/^ / % , 19
Pursuant to written applicatior, permission is hereby ranted to the Licensed rain Layer named herein to perform
the work indicated be w at C Z t '
on the
side, between
at premises owned by c
whose address is
and to _�ay House Drain, Repair H se Drain, Lay-Main, Other
for
occupancy or use,
with Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( j, 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
-)4p— Signed
Connection Charge Paid /3 df Licensed Drain ayer
7/S I-7 Issued by
Tax Collector
DO
Permit Nee:. Paid $
INSPECTION: Check Number: Q'7
INITIAL (Sig)
FINAL (Sig)
APPROVED 7 37 T� (Date)
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(Sig)
INSPECTOR
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION " ' 5-
OWNER
L TYPE 0 F RK vi, A t. ), 7�•
DATE PERMIT /(' PIPE '
t. INSTALLER
INSPECTOR DRAWN BY