HomeMy WebLinkAboutDrain Layers Permit 44 Elm Street ' tT WN OF ZlTH VI N JSOR
EPARTMENT OF POLLUTION CONTROL ;',
South Windsor, ConfiCcfidUf
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DRAIN LAYER'S PERMIT 'O 254
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at
on the ,
side,4a; W
at premises owned by __"
whose address is
and to ,. Lay House Drain, Repair House Drain, Lay Main, Other
for 4 occupancy or use,-,
with Family Units, with acres.
Type of Sewage to be connected under this permit: _
SANITARY".SEWAGE INDUSTRIAL WASTES, OR
Connection will be made with 4
Permit to be issued to _f
t
the holder of Drain Layer's License No. Permit will expire on .,� 5 19
The undersigned Drain Layer hereby agrees to all the terms and conditions sec forth on the permi 'and the reverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No:
for street excavation.
SPECIAL CONDITIONS n 'r' "Y t _
Signed—,
Connection Charge Paid '$, IF
L''en iaih Dyer
=—�f `(Sig) Issued by Y f k
Tax Collector
Permit Fee:—Paid $_ �,; ,.
. INSPECTION: * _.
INITIAL
FINAL (Sig)
APPROVED��/ 3$ (Date)`
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.INSPECTOR .', Y
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NOTESSOUTH WINDSOR POLLUTION CONTROL
LOCATION Yt E/� 5
OWNER Ca,✓o�
TYPE OF WORK
DATE 7 3 PERMIT PIPE ¢i ;
INSTALLER re d
INSPECTOR gA g
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