HomeMy WebLinkAboutDrain Layers Permit 6S 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 N? 2617
D , 19Z—
Pursuant to written applica i , perm'ssiion is tt,hereby n d to the Licen/ed Drain Layer named herein to perform
the work indicated below at '�� 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 ( ), 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 ag;ees 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
Connectio arge Paid 6'(J4 L Z_-- Licensed Drain Layer
Tax Collector
Permit Fee: Paid $
I•ATS•hI�T•=I9N:-- -- ---Gl�ecl�hT�mher• - - -- - -
- --- - - _- INITIAL (Sig)
- - FINAL (Sig)
APPROVED (Date)
— - - -- - - - -- - - -(Sig)
INSPECTOR