HomeMy WebLinkAboutDrain Layers Permit 678 Griffin Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List No.: _
DRAIN LAYER'S PERMIT NO 2571
Pursuant to written applicatior, permission is hereb"rante# to the Licensed Drain Layer named herein to perform
the work indicated below at
on the
side, between
at premises owned b AJ. L���
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 CH D Permit No.
for street excavation.
SPECIAL CONDITIONS
Blab (o -al¢C
�f
Connection Charge Paid "T .60 Signed Licensed Drain Layer
Tax Collector Issued by
Permit Fee: Paid $
INSPECTION: Check Number:
dzC y`
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR