HomeMy WebLinkAboutDrain Layers Permit 140 Fairview Drive Y TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.: _
South Windsor, Connecticut -/
List No.:
DRAIN LAYER' S PERMIT N? 2471
Pursuant to written application, er_mission is=bynted to the Licensed Drain Layer named herein to perform
the work indicated below at on the
side, betwf en
at premises owned by <
whose addr, �is
and to Lay House Drain, / Repair House Drain, Lay Main, Other
for occupancy or use,
with Family Units, with acres.
Type of Sewage ytobD connected under this permit:
SANITARY SEWAG ( 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
6 ll ��)7 Signed
Connection Charge Paid tice s;ed Drain yer
_GEC
Issued by
Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED 4 (Date)
(Sig)
INSPE
� 3,y
7e
j
DOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION C � ,ems
OWNER �
TYPE OF WOP9s-
DATE /', `F/ PE ITS 7 PIPE
INSTALLER
INSPECTOR DRAWN BY .