HomeMy WebLinkAboutDrain Layers Permit 69 Hazel Street (2) TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PYL�UT.ION CONTROL
B/P No.:
South Windsor, Connectitut �
List No.: _ 46 7
DRAIN LAYER'S PERMIT 6
7
2
t , 19
Puisuant to written'applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below,at on the
side, between
A premises owned by.
��►
whose address is
and to JL—_Lay House Drain, Repair House Drain, Lay Main, O"ther
for ,
occupancy or use,
with Family'Units, with „ : acres.
Type.of Sewage to be connected under this permit:
SANITARY SEWAGE (X j, INDUSTRIAL WASTES .( OR ( )
Connection will be made with
Permit to be issued,to
the holder of Drain Layer's License No. ~
z Permit will=expire on 19
The undersigned Drain Layer hereby agrees to all the terms-and condition's set forth on the peribit 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 # -
Tax Collector
Permit Fee: Paid $ _
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (S1g)
APPROVED' (O_-42k (Date)
- _ + -
---- ---- - (Sig)
INSPECTOR' .`