HomeMy WebLinkAboutDrain Layers Permit 4A St. Marc Circle TOWN Of SOUTH VI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.: _
South Windsor,Connecticut
List No.: _
DRAIN LAYER'S PERMIT N0 2869
Pursuant to written applicatio/r, perTission is hereby g/ranted to the Licensed Drain Layer named:herein to perform
the work indicated below at _�7 :�J - ��� (�/�^, on the
side, bet w�eec / r,
at premises owned by / J, LV -�f
whose address is
and to Lay House Drain, Repair House Drain, Lay Main, Ocher
for
occupancy or use,
with Family Units, with r acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( ), INDUSTRIAL WASTES .( ), OR
Connection will be made with
Permit to be issued to
the holder of Drain Layer's License No. Permit will expire on l9
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 •00 Licensed Drain Layer
- Issued-b
lax Collector
Permit Fee: Paid $
- - - ---- - - - _INSPEGTION:-- - --Cheek Number:-
INITIAL (Sig)
FINAL (Sig)
(Date)
-- ---- - (Sig)
INSPECTOR