HomeMy WebLinkAboutDrain Layers Permit 431 Governors Highwa TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List.No.:
DRAIN LAYER' S PERMIT No 1876
jv'� Z 7 , , 19 _
Pursuant to written applicatior, permission is hereby granted to the Licens d Drain Layer named,herein to perform
the work indicated below at vb on the
side, between
at premises owned by d �
whose address is
and to Lay House Drain, Repair House Drain,_ Lay Main, Other
for OPivt� i�'-• y ^
occupancy or use,
with Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( j, INDUSTRIAL ASTES .(!/<,-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
c Gt_ / s Signed
Connection Charge Paid ) 000. b o Lice sed Drain Layer
Tax Collector Issued.by
Permit Fee:. Paid $ 00 /
INSPECTION: Check Number: f/S-
3
INITIAL (Sig) 5'3/ 6`6
FINAL (Sig) h �1c1rS
APPROVED (Date)
(Sig)
INSPECTOR