HomeMy WebLinkAboutDrain Layers Permit 63 Foster Street ` ` TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
- ' South Windsor, Connecticut
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,fry' DRAIN LAYER'S PERMITO 260
19
3
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at ' y r A, w
5 on the
side, between
at premises owned by_ J u:';i i
whose address is
and to " Lay House Drain, Repair House Drain, Lay Main, Other
for
occupancy or use,
with ;" f,; Family Units, with acres.
Type of Sewage to be connected under this permit:
(SANITARY SEWAGE) INDUSTRIAL WASTES, OR
Connection will be made with 41
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 permi and the reverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No
for street excavation.
SPECIAL CONDITIONS` =' '
A-
3 Signed a
Connection Charge Paid $ g ._ Licensed Drain Layer
(Sig) issued by
Tax Collector
' Permit Fee: Paid $ IS7&d
INSPECTION:
INITIAL {� (Sig)
FINAL /k V (Sig)
APPROVED *7.T (Date)
(Sig)
INSPECTOR
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NOTES SOUTH WINDSOR POLLUTION CONTROL-
- LOCATION
OWNER
TYPE OF WORK
DATE 4 PERMIT :_ PIPE ;�`
INSTALLER L.a,,- so
INSPECTOR f DRAWN BY `�}�.