HomeMy WebLinkAboutDrain Layers Permit 5N St Marc Circle TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL BAP No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT
O 3151
19 _
Pursuant to written app//li��catior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at /V :� .(!�. ?'?���I �/ �Q�
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 ( ), INDUSTRIAe,WASTES _( ), OR ( )
Connection will be made with
i
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 i �,/pQ• Licensed Drain Layer
issued by
-
Tax Collector
Permit Fee: Paid $ _ _Q
INSPECTION: Check- Number. - 4 -
__ INITIAL (Sig)
- FINAL -- (Sig)
APPROVED (Date)
INSPECTOR (Sig)