HomeMy WebLinkAboutDrain Layers Permit 55 Glenwood Road TOWN of OIL WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List.No.: v_ .'
`DRAIN LAYER'S PERMIT
p 57
2
17 19
Pursuant to written application, permission is hereby.granted to the Licensed Drain Layer named herein to perform
the work indicated below at MM jaw st. on the
it - side, between y!t !tj
at premises owned by
whose address is
and to Lay House Drain, Repair House Drain, Lay-Main, Other _
for �
occupancy or use,
Rrith Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( ), INDUSTRIAL WASTES .( ), OR
Connection will be made with 6 sulatio Ave
Permit to be issued to
the holder of Drain Layer's License No. Permit will expireion- ` 19
The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on the permit and the reverse side
thereof. ApplicantAs ;eceived Town Permit No. and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS
Signed
Connection Charge Paid Licensed Drain Layer
Issued by �• _
Tag Collector
Permit Fee: Paid $ ' __
f INSPECTION: Check Number:
` INITIAL (Sig)
FINAL (Sig)
- APPROVED ? 4 „ (Date)
(Sig)
a : INSPECTOR
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TES SOUTH WINDSOR POLLUTION CONTROL
LOCATION s G��•� ��•a J
OWNER
TYPE OF WORK
DATE .f'i V. 7 PERMIT i7.Z PIPE ACVc,
INSTALLER m o rv<
INSPECTOR J DRAWN BY ,j