HomeMy WebLinkAboutDrain Layers Permit 30 Grace Road n..- . TOWN OF SOUTH WI N DSOR
DEPARTMENT. OF POLLUTION CONTROL
B/P No.:
a South Windsor, Connecticut �y►
List No.: r
DRAIN LAYER'S PERMIT
p 696
, 19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at Awd
on the
ftet
w.
side,01M imorthftat owrAr of 2r,%ft &WA aa t
at premises owned by t
whose address is
and to Lay House Drain, Repair House Drain, Lay-Main, Other
for occupancy or use,
with- M ( ,) Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE (I ), INDUSTRIAL WASTES _( ), OR ( )
Connection will be made with ' pipe t3 a a .*1 ; ' at a
�=r
r
Permit to be issued to w1miavem
a
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
Signed . tom.
Connection Charge Paid -" Licensed Drain Layer
xw—in goo Issued by
Tax Collector
145 tie
Permit Fee:. Paid $
INSPECTION: Check Number:
INITIAL td *914 (Sig)
FINAL /140 (Sig)
APPROVED _ 446 et~.- t�'�: (Date)
IN T S C0R (Sig)
a -