HomeMy WebLinkAboutDrain Layers Permit 716 Griffin Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL gip No.:
South Windsor, Connecticut
List No.:
DRAIN LAYER'S PERMIT NO 2738
19 t-3
Pursuant to written applicati/or, permis ion is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at 5- / . ri lt, 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 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
Signed
Connection ge Paid 3 Licensed Drain Layer
- -- Issued by
Tax Collector - - --
Permit Fee:. Paid $ _ j �3
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
- INSPECTOR (Sig)
1