HomeMy WebLinkAboutDrain Layers Permit 1326 Ellington Road 4 - TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List No.: rx.1.62.0
DRAIN LAYER'S PERMIT NO 1642
a&nda - 19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at CO on the
side, between — e
at premises owned by—
whose address is—.
and to 1Y Lay House Drain, Repair House Drain, Lay Main, Other
for /?1��,r occupancy or use,
with Family Units, with acres.
Type of Sewage;to be c nnected under this permit:
SANITARY SEWAGE �, INDUSTRIAL WASTES .( ), OR
Connection will be made with �e
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 -7q Licensed Drain Layer
Tax Collector Issued by
Permit Fee:. Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED 29 (Date)
(Sig)
INSPECTOR
N
d
5.� p
�Xr Si/A1G1 t_ A-T.
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION E,
OWNER v
TYPE OF WORK
DATE PERMIT PIE
INSTALLER
INSPECTOR DRAWN BY