HomeMy WebLinkAboutDrain Layers Permit 72 Graham Road TOWN OF SOUTH. WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
T List No.: 4AAM
DRAIN: LAYER',S PERMIT N� 721
at am"ia 1:19_
Pursuant torwritten application,permission is hereby granted to the Licensed Drain Layer named her to-perform
the work indicated below,at 4MAIIIIIII on the
side, between ANOM jig
at premises owned -
L
whose address-is >and to A Lay House Drain, ;Repair House Drain, Lay Main,: _,,,,__Other
for elm@ occupancy or use,
with lE Family Units, ;With acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( j, INDUSTRIAl:'WA+�STES .( ), OR
-Connection will be m de with 861101111110
. � Permit to be issued to
the holder.of Drain Layer's License No. " Permit will expire or a 19
r The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on the permit and the reve;se'side
thereof. Applicant has received Town Permit No. " and/or (n H ID 'Permit No.
for street excavation.
SPECIAL CONDITIONS .
Signed
Connection Charge Paid "` i¢ sed Drain Layer
_ }..
Tax Collector`
Permit Fee:.,Paid $
`"'"C
INITIAL t". (Sig)
FINAL (Sig)
APPROVED h (Date),
At .3t
o- (Sig) +
INSPE. R