HomeMy WebLinkAboutDrain Layers Permit 191 Farmstead Drive a TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List No.:
DRAIN LAYER',S PERMIT NO 1645
r
, 197
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at ZoZ ZE/�� on the
side, between
at premises owned by
whose addres is
and to Lay House Drain, Repair House Drain, Lay-Main, Other
for Z- occupancy or use,
with Family Units, with acres.
Type of Sewage 7�bonnected under this permit:
SANITARY SEWAGE ( DUSTRIAL 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 ,
SigneaX414,L)
Je
Connection Charge Paid f'3�7 Licensed Drain Layer
Tax Collector Issued by
7 Permit Fee:. Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED I Z (Date)
(Sig)
INSPECTOR
i r
N
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER a -
TYPE OF WORK
DATE l ;',?, G PERMIT PIPE
INSTALLER
INSPECTOR.,. Z-'Cn.", DRAWN BY