HomeMy WebLinkAboutDrain Layers Permit 179 Farmstead Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.: /f Z<S
List.No.: _ U
DRAIN LAYER'S PERMIT
O 1261
,7- W , 19.7.E
Pursuant to written applicatior, ermission is hereby granted to the Licensed Drain Layer named herein to perform
Ct�,
the wor 'n�dcated below atf/�/� L�/ '/ on the
side, bet
at premises owned by /c,0
whose address is
and to —XLay 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 (`-A-, INDUSTRIAL ASTE /)''FOR ( )
Connection will be made with_ G�' l
P
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 (N
Connection Charge Paid "7 7 Licensed Drain Layer
Issued by
Tax Collector
Permit Fee: Paid $ _ /S!0Q
INSPECTION: Check Number: 3 3
INITIAL (Sig)
FINAL I (Sig)
APPROVED i"� ' "� 1. 77 (Date)
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INSPECTOR (Sig)
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NOTES SOUTH WINDSOR POLLUTION CONTROL
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LOCATION
OWNER .
TYPE OF WORK 160
DATE 7-/ =7 PERMIT/ / PIPE
INSTALLER
INSPECTOR - ' / DRAWN BY