HomeMy WebLinkAboutDrain Layers Permit 6K St Marc Circle (2) TOWN' .OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT NO 3170
q 119
Pursuant to written app icatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at on the
side, b ween /
at premises owned by / ' a /'
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
s '
Permit to be issued to
the holder of Drain.Layer's License No. Permit will expire on 19
F+ 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
J`i 9 O h Signed
Connection Charge Paid Z b, 6 dQ Licensed Drain Layer
Issued by
x ecC;- ll.l.2a hh
Permit Fee: Paid $
_ -INSFECTIbN __.._ _ _Ch`eck Number —_--1767
INITIAL (Sig)
— FINAL (Sig)
APPROVED (Date)
(Sig) - -
INSPECTOR