HomeMy WebLinkAboutDrain Layers Permit 1E St Marc Circle TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT NO 2798
G I , 19�.'
Pursuant to written applicatior, permission is he eby granted to the (Lie e�d Drain Layer named herein to perform
the work indicated below at " ( on the
side, be e n
at premises owned by ) _L
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'hoider 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
d Signed
C nnection Charge Paid (yo
I3'�',3 Licensed Drain Layer
---- _ Issuedv -
Ta ollector n yam/
�
l-li��V�� � Permit Fee:. Paid $
---- - -- ._ _ --INSPECTION: Check Number-
INITIAL (Sig)
FINAL (Sig)
APPROVED -- _ (Date) -
-- _ (Sig)
INSPECTOR