HomeMy WebLinkAboutDrain Layers Permit 713 Griffin Road TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
South Windsor, Connecticut B/P No.:
List No.: _
DRAIN LAYER'S PERMIT N? 1217
Pursuant to written applicatior, permission is by grante to the Licensed Drain Layer named herein to"perform
the work indicated ow at �I� �� /yJ CT . on the
side, between
at premises owned by C-M4 ,—ol
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 M, INDUSTRIAL yWASTES .( ), 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. ®61 1& _and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS
� J Ufa
49�-j ,�,
Signed
Connection Charge Paid Licensed Drain Layer
- Issued by
-.Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number: 2
INITIAL (Sig)
FINAL (Sig)
APPROVED �� .� .(Date)
(Sig)
- INSPigtTOR
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION "
.OWNER,C o Ei'
TYPE OF WORK
DATE -16- PF.RMIT PIPE
INSTALLER ,
INSPECTOR 4C7671y DRAWN BY