HomeMy WebLinkAboutDrain Layers Permit 1N St Marc Circle �, •Tti. -" .. s]Y{: ♦. ....r...-qsiMyra':�. �.P7Yd+4\9[.•,(r;-c.._�Ta'.,�.-....inr�j=z�'-Tr.'S
TOWN OF SOUTH WI N DSOR 1T T E ,1Y F�'«Jfi
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No,:
List No.: _
DRAIN LAYER'S PERMITS 3143
( '.fJ , 19
Pursuant to written applicatior47rmission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at c
on the
side, between
at premises owned � y ''
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:
SANITARYSEWAGE ( ), 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 -//'00. Licensed Drain Layer
-:Issued-by-
Tax Collector
Permit Fee: Paid $ _ V(J_
INSPECTION: Check-Number,
INITIAL (Sig)
_ FINAL (Sig)
APPROVED (Date)
-- _- - - (Sig)
INSPECTOR