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TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List.No.: _
DRAIN LAYER'S PER O 3230
, 19 L)
Pursuant to written app icatior,Lpermission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at_ rl.C/T �- on the
side, b tween
at premises owned by - 6:�2:= b. A,,�C
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
7 Signed
C nection Charge Paid dU, a Licensed Drain Layer
issued y
T olle r
Permit Fee: Paid $
INSPECTION: `Check Nnmer.
INITIAL (Sig) '
FINAL (Sig)
3
APPROVED (Date)
(Sig)
INSPECTOR