HomeMy WebLinkAboutDrain Layers Permit 41 Hayes Road (2) TOWN OF SOUTH VYI N DS.OR.,
. .
D: ,PARTMENT OF 'PO 'L<jtION CONTROL
B/P No.:'
4M South Windsor, Connecticut
List No:. """ .
DRAIN LAYER'S PERMIT a4
!' 19 }
Pursuant to written applicatior, permission.is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below;at .� on the "
si4e,:between
at premises-Qwned by
whose address is
.'and to —41 _Lay House Drain, Repair House Drain, Lay Main, Other
for occupancy or use,
with Family Units,with aetes.
Type of Sewage to be connected.under,this permit;
SANITARY SEWAGE ( j, INDUSTRIAL WASTES .( ), OR ( '
Connection will be made with >
r.
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 Charge Paid Licensed Drain Layer.
Issued by ..
Tag Collegtor
Pert iit Fee: Paid $ _
INSPECTION: Check Number:
INITIAL
(Sig)
FINAL . ~
a` APPROVED (Date)
C R
(Sig)