HomeMy WebLinkAboutDrain Layers Permit 140 Fairview Drive (2) TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTRO
L
South Windsor, Connecticut B/P No.:
List No.: _
DRAIN LAYER'S PERMIT N? 2471
Pursuant to written applicat or, ermission is he eby granted to the Licensed Drain Layer named herein to perform
the work indicated below at f
on the
side, betw en
at premises owned by
whose address is
and to Lay House� Drain, - Repair House Drain, La Main Y , Other
for
occupancy or use,
with Family Units, with
acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( j;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 1
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 Licensed Drain Layer
L1�a�( Issued by Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number:
— ---INITIAL
(Sig)
FINAL (Sig)
INSPECTOR (Sig)