HomeMy WebLinkAboutDrain Layers Permit 52 Gail Lane TOWN OF SOUTH WI NDSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT NO 2515
19 4p,
Pursuant to written a7-1
catiorr,_permissio s he/eby Anted to the L�censsed Drain Layer named herein to perform
the work indicated below at & 3 7 CUJ/ A-9.9-1 5d� on the
side, between
at premises owned by—
r
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
f 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
1� Signed
Connection Charge Paid 7.Q�, Licensed Drain Layer
_. .Issued-.b =._.
ax Collector
Permit Fee:. Paid $
INSP-_ECTION:-.--.-- ._Che&__N mbex:_
- _INITIAL. (Sig) -
FINAL (Sig)
(Date)
(Sig) - --
- - INSPECTOR