HomeMy WebLinkAboutDrain Layers Permit 5B St Marc Circle TOWN OF SOUTH WINDSOR
_DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List No.: _
DRAIN LAYER'S PERMIT N0 264.4
..J , 19
Pursuant to written applicat' r, permissi n is hereby gran d to the Licensed Drain Layer named herein to perform
the work indicated below at on the
side, between
at premises owned by—-
V
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 ( ), INDUSTRIAL WASTES
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
q Signed
Connection ge Paid / < ems- Licensed Drain Layer
Issued b
ax Collector `
Permit Fee:. Paid $ _�
--Check-Number:- _--�-1 G.---- ----
_- INITIAL
(Sig)
FINAL (Sig)
(Date)
- (Sig)-
INSPECTOR