HomeMy WebLinkAboutDrain Layers Permit 9 Gail Lane sTOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut � _
List.No.: �` � l
DRAIN LAYER'S PERMIT NO 2021
-
, 19 O
Pursuant to written applicatior, permission is hereby F ted to the een,,s(ed Drain Layer named herein to-perform
the work indicated bel w at 11 ��/�.� ,
on the
side, between
at premises owned by n1��
whose address is
and to Lay House Drain, Repair House Drain, Lay Main, Other ,
t �
for rlfm� occupancy or use,
with ( Family Units, with acres.
Type of Sewage to be connected under this permit: roc tyJ
SANITARY SEWAGE ( INDUSTRIAL WASTES .( ), OR ( )
Connection will be made with
Permit to be issued to C�i''Zl�"'l.• }fin
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
Connection Charge Paid W o Licensed Drain Layer
o�-jz�dpZv-e-'-�Issued by _
Tax Collector
Permit Fee Paid $
INSPECTION: Check Number: l �
INITIAL (Sig) n�lcV
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
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