HomeMy WebLinkAboutDrain Layers Permit 571 Graham Road n _
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT
O
2553
C� 1
Pursuant to written appl*catior, permissions h by gr nted to the Licensed Drain Layer named herein to perform
i
the work indicated below at b on the
side, bet een
Iat premises owned b. �.m C
whose address is
I: 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 { j, INDUSTRIAL WASTES :( ), OR ( . j
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
Signed
C5nnection Charge Paid -Ln" S `� � Licensed Drain Layer
— — -A Issued b
� Colle
V h Q•c -� Permit Fee: Paid $
' _ .: - - �---�—INS•REE-T�BN�— ----�Check�_Number:._- i --�_ _ _ _
INITIAL - —(Sig-)--
(Sig)
OVED (Date)
(Sig)- --
�- INSPECTOR