HomeMy WebLinkAboutDrain Layers Permit 608 Governors Highwa TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut , J
List.No.:
DRAIN LAYER'S PERMIT NO 1681
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Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at 0 O U e � i1e- r S 1 (n.w a t
"\ on the
side, between' //
at premises owned by— a b 1 e—
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 /., 12 U
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
Signe dz'
Connection Charge Paid 1 3 Licensed Drain Layer
Issued b -
Tax Collector
0
rmit Fee: Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL 4 (Sig)
APPROVED L (Date)
AL e��tz
INSPE OR (Sig)
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—NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION �ar� c�ss w
OWNER
TYPE OF WORK t( /{ a
DATE w PERMIT PIPE
INSTALLER
INSPECTOR / DRAWN BY '�