HomeMy WebLinkAboutDrain Layers Permit 173 Fairview Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List No.: _
DRAIN LAYER'S PERMIT N? 2633
Pursuant to written ap 1J�a�tior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at
on the
side, between
at premises owned by_ L
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 ( ), 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
Signed
Connection Charge Paid 0o Licensed Drain Layer f
Issued by
ax Collector
Permit Fee: Paid $ _�5 O�9
INSPECTION: Check Number:
INITIAL (Sig)
FINAL
_ (Sig)
` APPROVED (Date)
INSPECTOR (Sig)