HomeMy WebLinkAboutDrain Layers Permit 209 Graham Road f VW11 yr wuTH WINDS
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No..
List No.: _
DRAIN LAYER'S PERMIT ? 2953
1
19 fi a
Pursuant to written applicatior, perm; ion is here grante to the Licensed Drain Layer named herein to perform
the work indicated below at `� p orm
side, between on the
at premises owned by
•
whose address is
and to Lay House Drain, - Repair House Drain,
Lay Main, Other
for
with occupancy or use,
Family Units, with
acres:
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( ), INDUSTRIAL WASTES .( ), OR ( )-
Connection will be made with
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------------
Permit to be issued to
the holder of Drain Layer's License No.
Permit wexpire on
The undersigned Drain Layer hereby, agrees to all the terms and cond tions s tl forth on he permit and the reverse side thereof. Applicant has received Town Permit No.
for street excavation. and/or C H D Permit No.
SPECIAL CONDITIONS
4 3 31 -
Connection Charge Paid Signed
D U Licensed Drain Layer
d by
Tag Collector Issue -
Permit Fee: Paid $ _2 G G
INSPECTION: Check Number: `✓Y
-
(Sig
APPROVED (Sig)
(Date)
INSPECTOR (Sig)