HomeMy WebLinkAboutDrain Layers Permit 35 Henry Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL gip No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT N� 3404
19-al
Pursuant to written'applicatio permission phereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at f on the
side, between
at premises owned b
whose address is
and to Lay House Drain, Repair House Drain, Lay Main, Other
i 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 wi1j 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
)6q°'17 A WOb.D�t Signed
o ~
Connection Charge Paid y Licensed Drain Layer
Issued by
agC or ( • '„
1L,C.�I Permit Fee: Paid $1//_�!�._
- INSPECTION: Check Number: cJ d
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date) /
-- - --- - (Sig) -
INSPECTOR