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TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List.No.: _
DRAIN LAYER'S PERMIT 0 3198
, 19
Pursuant to written ap licatitior, permission is hereby granted to the Licensed Drain ayer name herein to perform
the work indicated below at "1 `t GAS L on the
side, between at premises owned b Yfhr;d�C.., / C
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 ( ), INDUSTRIAL 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
r
9 �-
Signed
Connection Charge Paid Licensed Drain Layer
issued by
(� T9x Collect r
ollectRr ,
Permit Fee:. Paid $
INSPECTION: ---Cheek--Dumber:--
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
r (Sig)
INSPECTOR