HomeMy WebLinkAboutDrain Layers Permit 642 Governors Highwa TOWN OF SOUTH WINDSOR
.: DEPARTMENT OF POLLUTION CONTROL
' B/P No.:
South Windsor, Connecticut
List.No.: _ 6 / (7
DRAIN LAYER'S PERMIT NO 1711
19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at &/ 4.) v G r �d C c..w on the
side, between
at premises owned by
whose address is
and to Lay.House Drain, Repair House Drain, Lay-Main, Other ,
for occupancy or use,
with L' 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 (e � ,.� ✓1 Ar
the holder of Drain Layer's License No. Permit will expire on l9
The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on the-TiimlFain-2 the reverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS
L� Signed
Connection Charge Paid Lt l Licensed Drain Layer
4 -0 Issued by -- - -
Tax Collector
Permit Fee:. Paid s _ LS,.LO) e-) _
INSPECTION: Check Number: Z
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
f Q
-2 " / -7 (Sig)
INSPECTOR
M "
Y
N
9�ru�C 1 ticcS
�y-
r�G�+P
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—NOTES SOUTH WINDSOR POLLUTION-CONTROL
LOCATION ')e e, N a
OWNER
TYPE OF WORK
DATE 7 l8 7YPERMIT I711 PIPE 6,
INSTALLER C-6 Urn/
INSPECTOR DRAWN BY