HomeMy WebLinkAboutDrain Layers Permit 154 Gail Lane 77
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL gip No.:
South Windsor, Connecticut 5Pa-c�;2s�
List No.:
DRAIN LAYER'S PERMIT NO 2374
19
15 4 A CuL 1.,aat el
Pursuant to written applic tior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at 3 �` on the
side, berw-eeen
at premises owned by—
whose address is
and to Lay 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 ( j, INDUSTRIAL WASTES .( ), OR
Connection will be made with
Permit to be issued to
the holder of 0#in Layer's License No. Permit will expire on 19
The undersigned Drain Layer her 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
Connect arge Paid �(� t �� Licensed Drain Layer
---- - ---
y--- —
Tax Collector
Permit Fee:. Paid $
----- --- ----- _ _ INSPECTION: _ _ Cheek Number: --
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
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NOTES - SOUTH 14INDSOR POLLUTION CONTROL - -
LOCATION o ��'
OWNER �`%`� 3—
TYPE OF WORK t
DATE : - ? ('7! PERzfIT
INSTALLER
INSPECTOR C- DRAWN 'BY ;a