HomeMy WebLinkAboutDrain Layers Permit 112 Hayes Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.: `
South Windsor, Connecticut S(,113�,
List.No.: _
DRAIN LAYER"S PERMIT �d - f f74
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein toperform
the work indicated below at I Z k-GA'�I on the
0iZ:tt1 side, between
at premises owned by— , F''•C `-�w�Z�NE�
whose address is J ��rvtL
and to Lay House Drain, Repair House Drain, Lay-Main, Other
for <�` +�G-t-1Z+r>L occupancy or use,
with Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE , INDUSTRIAL WASTES OR ( ).
_ ConrectiQn-wi-it-be-made-with-
Permit to.be issued to
the holder of Drain Layer's j,icense No. Permit will expire on o��dGd �e �
5
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
Signedd4
Connection Charge Paid W Z,- `7"�o Licensed Drain Layer
Issued by
Tax Collector
Permit Fee:. Paid $
INSPECTION: Check Number: ,
INITIAL (Sig)
FINAL . /' (Sig)
APPROVED y (Date)
i
(Sig)
INSPECTOR
N
1
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION ill 43ges 'Rai-8
OWNER
TYPE OF WORK ik oa¢. Qx'--'AccALaA
DATEbe
qgv tcil PERMIT PIPE —PVC
INSTALLER vv► an
INSPECTOR�,r,jtg DRAWN BY