HomeMy WebLinkAboutDrain Layers Permit 1A St Marc Circle !' TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
l B/P No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT NO ' 2868
1,
Pursuant to written applicat/ior, permission is hereby grant to the Licensed Drain Layer named herein to perform
the work indicated below at
- T/ on the
side, between
at premises owned by L
r
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 connected under this permit:
SANITARY SEWAGE ( j,.INDUSTRIAL WASTES .( .), OR
Connection will be made with
e.
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�t and the reverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS
� 3/3
Signed
Connection Charge Paid .00_ Licensed Drain Layer
- --- —�� a Issued b -
ax collector `
Permit Fee: Paid $
-INSPECTION,: Check_Number:_
INITIAL (Sig)
FINAL (Sig)
E (Date)
-- - - - - -- - -(Sig)- -- - -- ------ ---
- - INSPECTOR