HomeMy WebLinkAboutDrain Layers Permit 1765 Ellington Road TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL BAP No.:
South Windsor, Connecticut
List.No.: _� J
DRAIN LAYER"S PERMIT NO 1223
'v , 19 /
Pursuant to written applicatior, permissio i he y granted to the Licensed Drain Layer named herein to perform
the work indicated below t— —f C.J�/;q ,17 ,
J on the
Wde,/be en �! 4z (/
at premises owned by eir"110, U
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 X INDUSTRI WAS S ), OR ( )
j/�
Connection will be made with -i y
-jj
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 d b Licensed rain aye
~ Issued by
Tax Collector
Permit Fee:. Paid $
INSPECTION: Check Number: 2-
INITIAL (Sig)
FINAL (Sig)
APPROVED —Z -- (Date) - -
(Sig)
INSPECTft
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NOT S SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER
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jli.r`, �al'✓ TYPE OF WORK
`�' DATE -/3- PERMIT PIPE
E INSTALLER
/ ` INSPECTOR DRAWN BY
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