HomeMy WebLinkAboutDrain Layers Permit 14 Grace Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.: "
South Windsor, Connecticut $—�,�/9/
List No.: _
DRAIN LAYER'S PERMIT
p 664
ept.3t. 1974 719
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at 14 tl mce Rand on the
side, between
at premises owned by IPM1 J. Nazaicki Jr,.
whose address is + �
and to X Lay House Drain, Repair House Drain, Lay-Main, Other ,
for Raai.dental occupancy or use,
with Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE (i(), INDUSTRIAL WASTES .( ), OR ( )
Connection will be made with PIABUO PLAR AV Solvent Joint)
Permit to be issued to Ad= Wi Mki
the holder of Drain Layer's License No. WT*9206— 59 . Permit will expire on JO/ /74 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`
Connection Charge Paid %//26/74 Licensed Drain Layer
W8 `i"� J e
-- Issued by nth
Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINALS" . (Sig)
APPROVED (Date)
yr :ff (Sig)
INSPECTOR
A I a
s
11E
t
t
N
I
-----------------
I
NO --- . - SOUTH--WINDSOR POLLUTION CONTROL
LOCATION
OWNER
TYPE OF WO s f
DATE PERMIT PIPE s�
INSTALLER
INSPECTOR - = ".' DRAWN BY