HomeMy WebLinkAboutDrain Layers Permit 1430 Ellington Road (3) TOWN OF SOUTH WI N DSOR
bEPARtMENT OF POLLUTION CONTROL gip No.:
South Windsor, Connecticut
List.No.: _
DRAIN LAYER'S PERMIT NO 1830
—��L �✓ .� , 19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to-perform
the work indicated below at 11130
on the
side, betwe
at premises owned
whose address is
and to Lay House Drain, Repair House Drain, Lay-Main, Other
_��.. 7
for f —occupancy or use,
with _ Family Units, with/ — acres.
Type of Sewage�to beecc nnected under this permit:SANITARY SEWAGE ( `, INDUSTRIAL WASTES ), OR ( )
Connection will be made with - � xi
k
Permit to be issued to f4r,�t �_ 1 �� v��✓� �
the holder of Drain Layer's License No. l/_ 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
;Co�nnea' arge Paid — NZl f Licensed rain L r
- 11C Issued by
Tax Collector
Permit Fee:. Paid $
INSPECTION: Check Number: y�8
INITIAL (Sig)
FINAL (Sig)
APPROVED � (Date)
(Sig)
INSPECTOR
N
�.5
v�
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION G
OWNER
TYPE OF WORK
DATE PERMITZ7 70 PIPE
INSTALLER
INSPECTOR DRAWN BY