HomeMy WebLinkAboutDrain Layers Permit 395 Graham Road TOWN OF •SOUTH WI N DSOR
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F DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut st 4114
Li .No.: _
DRAIN LAYER'S PERMIT
O 1212
rl/ 119
Pursuant to written applicZn�
n is by ranted to th Li ensed i Layer na ed herein to perform
the work 'ndicated below at *�it,�,,197 /
�� on the
side, between ,
at premises owned by—
whose address is
and to X—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 (,C), INDUSTRIA WASTE ( ), R ( )
Connection will be made with /I
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
Connection Charge Paid Licensed Drain L er
Tag Collector Issued by
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Permit Fee: Paid $ _ /`� ,0o
- - INSPECTION: Check Number: 9
INITIAL (Sig)
FINAL (Sig)
APPROVED P
� (Date)
(Sig)
INSPECTOR
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ENO XONING VIOLATIONS IF HOUSE ;
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TED AS SHOWN AND STAKED. I HEREBY
PROPERTY O F CORRECT ANftTiFY THIS MAP 'CO 68 SUBSTANTIALLY
OF CODE
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-NOTES SOUTH WIND OR POLLUTION CONTRO
LOCATION / ;a ,39
OWNER
TYPE OF WORK
DATE - -77 PERMIT )2/Z PIPE
INSTALLER
INSPECTOR Friv DRAWN BY C
TOWN OF SOUTH WINDSOR
TOWN HALL
SOUTH WINDSOR, CONN. 06074
DEPARTMENT POLLUTION CONTROL
Date 27
The Sanitary Sewer !�
• • • • • Septic System • • • •
at ��' _ . .
or lot #. . . . .�• . • • • • . , has been installed
in accordance with the Town of South Windsor ord completed
and regulations. es
Accepted n Approved
Y ✓ L�2 ¢ Date
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