HomeMy WebLinkAboutDrain Layers Permit 69 Hazel Street TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL
B/P No.:
South Windsor, Connecticut 1
List No.: _ ��- 4- 7 Z
DRAIN LAYER' S PERMIT N? 672
Uct. 56 1974 , 19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at 69 13amel ro&Ld Lo T 34) on the
side, between
at premises owned by Roland J. Ouellette
whose address is 5&0*
and to X Lay House Drain, Repair House Drain, Lay Main, Other
for Residential occupancy or use,
with One Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE (X), INDUSTRIAL WASTES ( ), OR ( )
Connection will be made with ZiX xnCh K&BtiC Pipe
Permit to be issued to Adam Wianieleki
the holder of Drain Layer's License No. W-9206559 Permit will expire on '1Z/8/74 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 Frank J• SMith
Tax Collector
I OC)*..
Permit Fee: Paid $
INSPECTION: Check Number: _
INITIAL (Sig)
FINAL (Sig)
APPROVED to-7!L (Date)
F
(Sig)
INSPECTOR
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-NOTES- UTHW aR MLLUT N CONTROL - - =-
LOCATION cf
OWNER
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DATE PERIT' PIPE
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INS .ECTQR DRAWN BY