HomeMy WebLinkAboutDrain Layers Permit 12E 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 N? 27 77
AtT 4a_k a/
Pursuant to written applicatior, permission is hereby grantee Licensed Drain Layer named herein to perform
the work indicated below at�� - L JQic:' on the
side, between
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 Layerls 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
// Signeu
Connection Charge Paid ry � Licensed Drain Layer
Igswe-d by
Tax Collector
Permit Fee Paid $
-- - -- - -INSPECTION: --Cheek-Number.
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR