HomeMy WebLinkAboutDrain Layers Permit 1B St Marc Circle r
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
_
South Windsor, Connecticut B/P No.:
List No.: _
DRAIN LAYER'S PERMIT NO 2870
Qa,7a -3
Pursuant to written appliica�tior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at on the.
side, betwe
Ien
� /
at premises owned by �� ./
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 corm.ected under this permit:
SANITARY SEWAGE ( j, 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 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 P,id _q Licensed Drain Layer
Issued-b - _
ax Collector
Permit Fee:. Paid $
A— ----- - - I�TSP_EC_TION:—_ - Check—Number: Id
— -- --- INITIAL (Sig)
FINAL (Sig)
(Date)
(Sig)._.
INSPECTOR