HomeMy WebLinkAboutDrain Layers Permit 4K 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 11T� 3139
, 19
Pursuant to written applicati�o/r, permis ion is hereby, grante�dp to the Licensed Drain Layer named'tierein to perform
the work indicated below at `'7 - )r { ( - ia �C
on the
side, between.
44-
at premises owned by tG 16 F I l^9 _ �' '1.. :
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
a1 yFIC� / /o
Signed
Connection Charge Paid Oo •0 C/ Licensed Drain Layer
issued y
Tax Collector
Permit Fee: Paid $
INSPECTION: _ __Check Nfimber: sue'
INITIAL (Sig)
- - FINAL
APPROVED (Date)
r.
(Sig)_
INSPECTOR