HomeMy WebLinkAboutDrain Layers Permit 4H St Marc Circle TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL Bhp No.:
South Windsor, Connecticut
List No.:
DRAIN LAYER'S PERMIT N? 2819
Pursuant to written applicatior, pe``rmjj ission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at 4" hd U + 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 { j, 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
Connection Charge Paid o 141 & Fr 3 Licensed Drain Layer
a- sued b
� . Tgd Collect�{
Permit Fee: Paid $
-- ---- --- - INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR - (Sig) -