HomeMy WebLinkAboutDrain Layers Permit 125 High Street ..1 = TOWN OF SOUTH WINDSOR
DEPARTMENT OF POLLUTION CONTROL2 of r
South Windsor, Connecticut S
List No.: 6,n,er
DRAIN LAYER' S PERMIT N? 734
9
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at �Z ;' "' '` ' on the
side, between S. ,,.� ,•LL s, ,i.
at premises owned by
whose address is
and to • Lay House Drain, Repair House Drain, Lay Main, Other
for ,•.r;;;•�-�+,i •,-t
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 431X—:;
Permit to be issued to
the holder of Drain Layers License No. Permit will expire on 'T"' 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 4
Connection Charge Paid R �' Licensed Drain Layer
•'"""+�,�':al: ' �' , i��'-°', .....
Tax Collector Issued by
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
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rs; aAI>j C C%_�
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION - ;
OWNER
TYPE OF WORK
DATE)III447,A PERMIT 234 PIPE '
INSTALLER
INSPECTOR r DRAWN BY �f