HomeMy WebLinkAboutDrain Layers Permit 249 Griffin Road TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.: _
List No.:
DRAIN LAYER'S PERMIT NO
3470
1900
Pursuant to written appliLc/atior, permission is he y gra ed to the Licensed Drain Layer named herein to erform
the work indicated below at' 7 p
side, between on the
at premises owned by
whose address is
and to Lay House Dra
for in, Repair House Drain,
Lay Main, Other
with occupancy or use,
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.
The undersigned Drain Layer herebe on y agrees to all the terms and conditions set Permit l exp for heron the permit and the reverse side
thereof. Applicant has received Town Permit No.
for street excavation. and/or C H D Permit No.
SPECIAL CONDITIONS
Connection Charge Paid 00, Signe
Licensed Drain Layer
Tag Collector Issued by
Permit Fee: Paid $ _ :L d6
INSP E TION: Check Number:
INITIAL (Sig)
FINAL
APPROVED (Sig)
INSPECTOR (Sig)