HomeMy WebLinkAboutDrain Layers Permit 6C St Marc Circle r
TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List.No.: _
DRAIN LAYER.'.S PERMITO 3120
� C 2- , 19 e3
Pursuant to written applica/tior, perm' sion is hereby granted to the Licensed Drain Layer named herein to perform
s the work indicated below at. I
on the
side, betwee
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 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 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
Connec ' n Charge Paid �/ L 3 Licensed Drain Layer
--- - - -
_...._..... ter•.
issued
by
-
Tax Collector
Permit Fee: Paid $
-INSPECTION: Check`•Number.
- -INITIAL (Sig)
FINAL
(Sig)
APPROVED (Date)
_ -- - (Sig) _.
INSPECTOR j