HomeMy WebLinkAboutDrain Layers Permit 632 Graham Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List No.: �Q/�Z
DRAIN LAYER'.S PERMIT NO 1943
19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to�per`form.
the work indicated below at on the
side, between
at premises owned by X e'
whose address is
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 nnected under this permit:
SANITARY SEWAGE ( )), INDUSTRIAL WASTES ( ), OR ( )
Connection will be made with l s �( ��C
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
.17
i�y�79
Signed
�e
Connection Charge Paid q60- ao Licensed i Layer
Issued by
Tax Collector
Permit Fee: Paid $ Da
INSPECTION: Check Number:
INITIAL (Sig) C$,,eq (2010 k4c flay\
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPE TOR
N
O � ►
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATIONS
OWNER `
TYPE OF WORK 5 A 2 t.Ca - G.A
DATE14414Z& PERMIT PIPE C
INSTALLER v o
INSPECT R DRAWN BY