HomeMy WebLinkAboutDrain Layers Permit 17B St Marc Circle TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:,
List No.:
DRAIN LAYER'S PERMIT
O 2693
19
Pursuant to written applicatior, permi'ss-on is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at �cl '��/x f��s �.�+ on the g
4
side, between
at premises owned by �'�
whose address is
and to Lay House Drain, Repair House Drain, Lay-Main, _Otherf
for '
occupancy or use,
with Family Units, with _- acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( ), INDUSTRIAL WASTES .( ), OR ( )
Connection will be made with
f:
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. r
for street excavation.
SPECIAL CONDITIONS
r
i
r
Signed
Connection Charge Paid Licensed Drain Layer
Issued by
- Tax Collector _Permit Fee: Paid $
INSPECTION. _ _._._C heck--Number.-—���� - - - --
INITIAL (Sig)
FINAL (Sig)
--APPROVED - - -- - - - (Date)
INSPECTOR --- (Sig)
-
k y.